MIGRAINE

TANYA SMITH · 2026 · Case ID: A26032128

MIXED

Summary

The veteran, who served in the United States Army from July 2000 to February 2003, appeals the denial of service connection for headaches, bilateral hearing loss, costochondritis, valvular heart disease, and asthma with chronic bronchitis. The Board granted service connection for headaches, finding that the evidence was in equipoise and resolving reasonable doubt in the veteran's favor, noting the onset of headaches during service despite a VA examiner's opinion that they were less likely than not related to service. The Board denied service connection for bilateral hearing loss, citing the lack of a current diagnosis of hearing loss for VA purposes as per audiometric studies, despite a private examiner's opinion estimating hearing loss. For costochondritis, valvular heart disease, and asthma with chronic bronchitis, the Board denied increased ratings. The Board found that the veteran's current symptoms and medical evidence did not meet the criteria for ratings higher than the already assigned 10 percent for costochondritis and valvular heart disease, and 30 percent for asthma with chronic bronchitis. The Board noted that private medical opinions concurred with the existing ratings for these conditions. The veteran's service MOS was infantryman, and he was deployed to Iraq.

Rationale

Evidence in equipoise; Resolved reasonable doubt in favor of Veteran; Credible evidence of onset coincident with active duty service

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

230705-361044

Full Decision Text

Citation Nr: A26032128
Decision Date: 04/08/26 Archive Date: 04/08/26

DOCKET NO. 230705-361044
DATE: April 8, 2026

ORDER

Entitlement to service connection for headaches is granted.

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to a rating in excess of 10 percent for costochondritis is denied.

Entitlement to a rating in excess of 10 percent for valvular heart disease is denied.

Entitlement to a rating in excess of 30 percent for asthma with chronic bronchitis is denied.

FINDINGS OF FACT

1. Resolving reasonable doubt in favor of the Veteran, his headaches are at least as likely as not etiologically related to his active service.

2. The Veteran does not currently have a diagnosis of bilateral hearing loss for VA purposes.

3. The Veteran's costochondritis has manifested as painful motion, with no rib removal.

4. The Veteran's valvular heart disease has manifested as a workload of 7.1-10.0 METs.

5. The Veteran's asthma with chronic bronchitis requires daily inhalational therapy and daily inhalational anti-inflammatory medication.

CONCLUSIONS OF LAW

1. The criteria for service connection for headaches have been met. 38 U.S.C. §§ 1110, 5107(b);?38 C.F.R. §§ 3.102, 3.303.?

2. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107(b);?38 C.F.R. §§ 3.102, 3.303, 3.385.

3. The criteria for a rating in excess of 10 percent for costochondritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.71a, Diagnostic Code (DC) 5297.

4. The criteria for a rating in excess of 10 percent for valvular heart disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.104, DC 7000.

5. The criteria for a rating in excess of 30 percent for asthma with chronic bronchitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.97, DC 6602.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from July 2000 to February 2003.

In the July 5, 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the November 2022 and June 2023 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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.

I. Service Connection

Generally, to?establish?service connection a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service."?Davidson v. Shinseki,?581 F
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.

I. Service Connection

Generally, to?establish?service connection a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service."?Davidson v. Shinseki,?581 F.3d 1313, 1315-16 (Fed. Cir. 2009);?Shedden v. Principi,?381 F.3d 1163, 1167?(Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes?that the disease or injury was incurred in service.?38 C.F.R. §?3.303(d).??

1. Entitlement to service connection for headaches.

In an August 2022 fully developed claim, the Veteran requested service connection for headaches contending "Having an infantry MOS, I began experiencing headaches during and after my military service. Due to my MOS I was continually exposed to stress and loud environments during my service." In a separate statement discussing his asthma and chest pain, the Veteran reported "I regularly experience chest tightness due to the costochondritis from the continual need for deep inhalations, which give me a frequent feeling of being fatigued, and leads to headaches." The Board notes that the Veteran is service-connected for both asthma with chronic bronchitis and costochondritis.

The Veteran was given a VA examination for his headaches in October 2022. Here, the examiner diagnosed migraine including migraine variant headaches and listed the date of diagnoses as 2001. The examiner later noted the date of onset of the Veteran's headaches as 2001 and wrote "In 2001, Veteran had to carry a lot of heavy gear on his back. He states that the straps would wrap around his trapezius and chest. He reports that he would have headaches that start in the back of the head, radiate from the neck all the way up. He states that he would usually ignore the pain and take Motrin as needed for headaches." The examiner opined that the Veteran's headaches have progressed/worsened since that time. However, in a separate opinion, the examiner opined that the Veteran's headaches are less likely than not related to his military service writing:

Service treatment records show that Veteran had a headache when he was diagnosed with an URI on 11/3/2001. This was acute only. The Veteran's history and lay evidence suggest that he has headaches which were related to his neck pain. Service treatment records are unremarkable for ongoing complaints of headache. There are no current medical records that demonstrate diagnosis of migraines. It is less likely than not that the headaches, diagnosed as migraines are incurred in service.

Based on this opinion, the AOJ issued a November 2022 rating decision denying service connection for headaches. The instant appeal ensued.

In support of his claim, the Veteran timely submitted a private report of consultation and examination. Here, the private examiner opined:

[The Veteran] states he suffered from headaches during active duty. He was treated by military medical personnel. He suffers from four or more headaches per week with an average duration of an hour depending on how quickly he can medicate and how efficient the medication may be when taken. He also suffers from two migraine headaches per month with the average duration of 3-4 hours depending on how quickly he can medicate and how efficient the medication may be when taken. Diagnosis: Chronic Headaches. Onset of this condition which persists to the present during active duty military service should qualify said condition for service connection. It is as likely as not that the condition is directly and causally related to [the Veteran's] military service. This is a permanent condition.

A review of the Veteran's service treatment records shows a complaint of headaches in November 2001 in conjunction with other symptoms diagnosed as pharyngitis/URI. However, the Board also notes the Veteran's theory of entitlement that his headaches may be secondary to his service-connected asthma with bronchitis and/or costochondritis was never developed. A review of the file shows that the AOJ never obtained medical nexus opinions addressing these theories of entitlement. Nevertheless, the Board finds the evidence of record to be in at least equipoise, noting that even though the VA examiner opined that the Veteran's headaches were not related to his active service, he repeatedly documented their onset as during the Veteran's active service and self-medication. There is credible evidence of the onset of the headache condition coincident with the Veteran's active duty service. See Flynn v. Brown, 6 Vet. App. 500, 503 (1994); 38 C.F.R. § 3.303(a) ("Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces."). Accordingly, resolving reasonable doubt in favor of the Veteran, entitlement to service connection for headaches is granted.

2. Entitlement to service connection for bilateral hearing loss.

In an August 2022 fully developed claim, the Veteran requested service connection for bilateral hearing loss and tinnitus. He reported that his MOS as an infantryman resulted in exposure to loud environments resulting in hearing loss and tinnitus. That same month, the Veteran was given a VA examination for hearing loss and tinnitus. Here, the examiner diagnosed tinnitus but found the Veteran to have normal hearing. Thus, in a November 2022 rating decision, the AOJ granted service connection for tinnitus and denied service connection for bilateral hearing loss, finding no diagnosis of hearing loss for VA purposes. The instant appeal ensued.

In support of his claim, the Veteran timely submitted a private report of consultation and examination in August 2023. Here, the examiner opined that the Veteran had an estimated 40 percent hearing loss in the left ear and estimated 30 percent hearing loss in the right ear which was directly and casually related to his military service. The examiner also noted that the Veteran was "asked to attend for a puretone audiogram and have the results of same sent to this office. When received same will be filed in this case as an addendum." The Board notes that no such addendum puretone audiogram was provided.

Under 38 C.F.R. § 4.85, a hearing loss disability must be established by specified audiometric studies. Under 38 C.F.R. § 3.385 hearing loss disability (for VA compensation purposes) is defined as existing when audiometry in the frequencies of 500, 1000, 2000, 3000 and 4000 Hertz produces a puretone threshold of 40 decibels or higher at any of those frequencies; when the puretone thresholds at 3 of the specified frequencies are higher than 25 decibels; or when speech discrimination by Maryland CNC list is less than 94 percent.

As the only puretone audiogram of record is that of the August 2022 VA examiner, the Board finds that the Veteran does not have a current diagnosis of hearing loss for VA purposes. As the first step in establishing service connection is the existence of a current disability, the Board finds that service connection cannot be established because the Veteran does not have hearing loss for VA purposes. Accordingly, entitlement to service connection for bilateral hearing loss is denied.

II. Increased Rating

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Pertinent regulations also provide that it is not necessary for all of the individual criteria to be present as set forth in the Rating Schedule, but that findings sufficient to identify the disability and level of impairment be considered. 38 C.F.R. § 4.21. If two disability evaluations are potentially applicable, the higher
from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Pertinent regulations also provide that it is not necessary for all of the individual criteria to be present as set forth in the Rating Schedule, but that findings sufficient to identify the disability and level of impairment be considered. 38 C.F.R. § 4.21. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

3. Entitlement to a rating in excess of 10 percent for costochondritis.

In a November 2022 rating decision, the Veteran was granted service connection for costochondritis, evaluated at 10 percent, effective January 22, 2022. In July 2023, he filed the instant appeal writing "costochondritis should be 30%".

The Veteran was given a VA examination for his costochondritis in October 2022. Here, the examiner noted that the Veteran reported his current symptoms as "a lot of musculoskeletal chest pain" and "pain as sore and tender to touch, worse with carrying heavy objects and bending". The Veteran was reportedly taking Ibuprofen 800mg for pain. Further within the examination report, the examiner noted that the Veteran had "anterior chest pain along the sternum: 'I have pain in the front of my chest and my ribs on both sides' pain is every other week depending on activity, lasting a few minutes to a couple of hours, pain is mild in nature". Finally, the examiner reported that the Veteran had not undergone any rib removal or resection.

The Veteran's costochondritis is evaluated under DC 5297 for ribs, removal of. Pursuant to DC 5297 a 10 percent rating is warranted for one or resection of two or more ribs without regeneration; a 20 percent rating is warranted for removal of two ribs; a 30 percent rating is warranted for removal of three or four ribs; a 40 percent rating is warranted for removal of five or six ribs; and finally a 50 percent rating is warranted for removal of more than six ribs.

As noted above, the August 2022 examiner found that the Veteran has not undergone any rib removal or resection. Instead, he has been assigned a 10 percent rating under DC 5297 for painful motion.

Under?38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however,?38 C.F.R. § 4.59?is not limited to disabilities involving arthritis.?See Burton v. Shinseki,?25?Vet. App.?1?(2011). The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. 38 C.F.R. § 4.59. It is the intention to recognize actually painful, unstable, or malaligned healed joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Id.

As the minimum compensable rating under DC 5297 is 10 percent and the Veteran is already assigned such, a rating in excess of 10 percent is not warranted. The Board notes that neither the Veteran, nor his representative has provided any medical evidence in support of this increased rating claim. Instead, the Veteran's private examiner noted in his August 2023 report that the Veteran was service connected at 10 percent for his costochondritis "to which the undersigned examiner concurs." Accordingly, entitlement to a rating in excess of 10 percent for costochondritis is denied.

4. Entitlement to a rating in excess of 10 percent for valvular heart disease.

The Veteran was granted service connection for valvular heart disease in a November 2022 rating decision, evaluated at 10 percent, effective January 22, 2022. In July 2023, he filed the instant appeal writing "valvular heart disease should be 60%".

The Veteran was given a VA examination for his valvular heart disease in August 2022. Here, the examiner reported the Veteran's current symptoms as chest pain and shortness of breath. The examiner engaged in interview-based METs testing and opined that the Veteran's symptoms during activity
excess of 10 percent for costochondritis is denied.

4. Entitlement to a rating in excess of 10 percent for valvular heart disease.

The Veteran was given a VA examination for his valvular heart disease in August 2022. Here, the examiner reported the Veteran's current symptoms as chest pain and shortness of breath. The examiner engaged in interview-based METs testing and opined that the Veteran's symptoms during activity were breathlessness, angina, and dizziness. His METs level was estimated to be 7-10 METs.

The Veteran's valvular heart disease is evaluated under DC 7000 for the same, which is evaluated under the General Rating Formula for Diseases of the Heart. Under the General Rating Formula for Diseases of the Heart, a 10 percent rating is warranted for a workload of 7.1-10.0 METs results in heart failure; or continuous medication required for control. A 30 percent rating is warranted for a workload of 5.1-7.0 METs results in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging). A 60 percent rating is warranted for workload METs of 3.1-5.0 METs in heart failure symptoms; and finally a 100 percent rating is warranted for workload of 3.0 METs or less results in heart failure symptoms.

As noted above, the August 2022 examiner found the Veteran's workload METs level to be at 7-10 METs, which is consistent with the already assigned 10 percent rating. The Board notes that neither the Veteran, nor his representative has provided any medical evidence in support of this increased rating claim. Instead, the Veteran's private examiner noted in his August 2023 report that the Veteran was service connected at 10 percent for his valvular heart disease "to which the undersigned examiner concurs." Accordingly, entitlement to a rating in excess of 10 percent for valvular heart disease is denied.

5. Entitlement to a rating in excess of 30 percent for asthma with chronic bronchitis.

The Veteran was granted a 30 percent rating for his asthma with chronic bronchitis in a June 2023 rating decision, effective December 9, 2022. In July 2023, he filed the instant appeal writing "asthma with chronic bronchitis should be 60%".

The Veteran was most recently given a VA examination for his asthma and chronic bronchitis in January 2023. Here, the examiner noted that the Veteran requires intermittent courses or bursts of systemic corticosteroids twice per year, and uses daily inhalational bronchodilator therapy and daily inhalational anti-inflammatory medication. The Veteran was also noted to use antibiotics for his bronchitis but was found to have no asthma attacks with episodes of respiratory failure in the past 12 months. Moreover, the Veteran was not found to have had any physician visits for required care of exacerbations. PFT results, of which the FEV-1 % predicted was the result found to most actually reflect the Veteran's level of disability was found to be 83 percent predicted.

The Veteran's asthma with chronic bronchitis is evaluated under DC 6602 for asthma, bronchial. Pursuant to DC 6602 a 10 percent rating is warranted for FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy; a 30 percent rating is warranted for FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication; a 60 percent rating is warranted for FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids; and finally a 100 percent rating is warranted for FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires
daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication; a 60 percent rating is warranted for FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids; and finally a 100 percent rating is warranted for FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications.

A review of the record shows that the Veteran requires daily inhalational bronchodilator therapy and daily inhalational anti-inflammatory medication, warranting the already assigned 30 percent rating. However, the evidence of record does not support a 60 percent rating because the Veteran has not shown FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. Instead, his FEV-1 precent predicted levels are consistently above 80 percent (see August 2022 and September 2022 PFTs results), and he has only required two visits per year for courses of systemic corticosteroids rather than three. The Board notes that neither the Veteran, nor his representative has provided any medical evidence in support of this increased rating claim. Instead, the Veteran's private examiner noted in his August 2023 report that the Veteran was service connected at 30 percent for his asthma with chronic bronchitis "to which the undersigned examiner concurs." Accordingly, entitlement to a rating in excess of 30 percent for asthma with chronic bronchitis is denied.

(continued on next page)

TANYA SMITH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Ruiz, 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.

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