MIGRAINE

Summary

The Veteran, an Army Veteran who served from August 1987 to August 1989, appeals the denial of service connection for migraine headaches. The Veteran contended that his migraines were secondary to his service-connected tinnitus. The Board reviewed the evidence, including lay statements from the Veteran's wife and a private medical opinion from a neuropsychologist, Dr. M. Dr. M. opined that the migraines were a direct result of tinnitus, citing literature suggesting a link and noting the absence of other clinical causes. However, the Board found this opinion lacked sufficient objective rationale, as it was based on a hypothesis and did not establish causation. The Board also considered a VA examination from October 2024, where the examiner opined that the migraines were less likely than not proximately due to tinnitus, citing literature that suggested comorbidity rather than causation. The examiner noted that migraines are multifactorial and attributing them solely to tinnitus was speculative. A subsequent VA examination in March 2025 reiterated that migraines are often idiopathic and that attributing them to tinnitus without supporting medical evidence is not objectively possible. The Board found the VA opinions more probative due to their objective rationale and expertise. Service treatment records showed a pre-service head injury with no post-service treatment records for headaches. The Board concluded that the criteria for service connection were not met, as the evidence did not establish a causal relationship between the migraines and service or tinnitus. The benefit-of-the-doubt doctrine was considered but found inapplicable as the persuasive weight of the evidence was against the claim. Service connection for migraine headaches was denied.

Rationale

Private medical opinion lacked objective rationale and established causation.; VA medical opinions found migraines less likely than not due to tinnitus.; Service treatment records did not establish a causal link.

Full Decision Text

Citation Nr: A26033629
Decision Date: 04/13/26	Archive Date: 04/13/26

DOCKET NO. 260114-624068
DATE: April 13, 2026

ORDER

Entitlement to service connection for migraine headaches is denied. 

FINDING OF FACT

The persuasive weight of the evidence is against finding that migraine headaches incurred in or were caused by the Veteran's military service or secondary to (caused or aggravated by) a service-connected disability. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for migraine headaches have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from August 1987 to August 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2025 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The rating decision on appeal constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

The Veteran timely appealed the rating decision by filing a January 2026 Decision Review Request. The Veteran elected Direct Review of his claim by a Veterans Law Judge. Therefore, only the evidence associated with the record at the time of the May 2025 rating decision will be considered on appeal.

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 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.

Entitlement to service connection for migraine headaches.

The Veteran contends that he developed migraine headaches secondary to his service-connected tinnitus. See generally, September 2024 VA Form 21-526EZ.  On a May 2023 statement, the Veteran's wife wrote that the Veteran experienced severe migraines due to his tinnitus. 

Regulations

Service connection may be granted for a 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).

Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a).

Under the AMA, the Board is bound by favorable findings by the agency of jurisdiction in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104 (c).

Evidence/Analysis

The May 2025 rating decision favorably found the Veteran has a current diagnosis of migraine headaches pursuant to the October 2024 VA examination. In addition, the primary condition of tinnitus is service connected. However, service connection was denied because the evidence for record did not show a causal relationship between the Veteran's military service or service-connected tinnitus. 

The Board has reviewed the evidence of record including the lay statements and finds that service connection is not warranted. Service treatment records indicate the Veteran had
.309(a).

Under the AMA, the Board is bound by favorable findings by the agency of jurisdiction in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104 (c).

Evidence/Analysis

The May 2025 rating decision favorably found the Veteran has a current diagnosis of migraine headaches pursuant to the October 2024 VA examination. In addition, the primary condition of tinnitus is service connected. However, service connection was denied because the evidence for record did not show a causal relationship between the Veteran's military service or service-connected tinnitus. 

The Board has reviewed the evidence of record including the lay statements and finds that service connection is not warranted. Service treatment records indicate the Veteran had head injury in 1982 prior to service. He reportedly suffered a severe concussion and was unconscious for several hours.  He was hospitalized for 4 days.  On the enlistment examination, it was written that the Veteran did not have recurrent headaches and that his head injury was fully healed. On his separation medical history in July 1989, the Veteran marked "Yes" for frequent or severe headaches. On the reverse side of the form, it was noted that the Veteran had mild headaches. On the July 1989 separation examination, clinical evaluation was normal.  No defects or diagnoses were noted.  He was qualified for separation.

The report of a medical history provided by the Veteran in January 1991 in connection with OCS shows that he denied having a history of frequent or severe headaches.  It was noted that he had a history of a head injury in 1982.  It was further noted that this resulted in a concussion from a fall from a diving board.  There were no sequelae.  The report of a medical examination conducted in January 1991 for the purpose of OCS does not contain any mention of headaches.  Clinical evaluation of the head was normal.  It was stated that there were no defects or diagnoses.

The Board notes the record does not include post-service treatment records from 1989 to 2010. The Veteran submitted a September 2024 private medical opinion written by Dr. M., a neuropsychologist. Dr. M. wrote that she treated the Veteran for many years. He first presented to her office 15 years prior for cognitive evaluation and psychological concerns secondary to hearing loss and bilateral tinnitus. The Veteran experienced symptoms related to both conditions. She referred to the Veteran to a neurologist who conducted an assessment. The results indicated no other clinical causes for the Veteran's migraines. Dr. M. opined that: 

"Based on my professional assessment and the findings of Dr. Neiman, it is my considered opinion that [the Veteran's] frequent migraines are a direct result of his service-connected disability of bilateral tinnitus. The relationship between tinnitus and migraines has been documented in the literature, and it is well established that the persistent discomfort and stress associated with chronic tinnitus can

contribute to the onset of migraine headaches."

The Veteran was evaluated during an October 2024 VA examination. The Veteran reported that his headaches started in 2021. He attributed the headaches to tinnitus. The condition worsened over time. The examiner opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner wrote:

"diagnosis is migraine headaches. Medical literature review did not yield any definitive study that establishes a causal relationship between tinnitus and migraines. The underlying causes of migraines are believed to be multifactorial and it is hypothesized that migraines are caused by genetic factors and various environmental factors (https://www.mayo clinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-0360201#:~:text=Stress%20at%20work%20or%20home, trigger%20migraines%20in%20some%20people). Thus, to attribute the cause of migraines primarily to tinnitus is speculative.

Published literature, including "Tinnitus and Headache" by Langguth et. al. (https://pubmed.ncbi.nlm.nih.gov/26583133/) establish that tinnitus may be comorbid (ie. co-occurring) with migraine headaches. The authors of the study sent questionnaires to patients with tinnitus and headaches to estimate prevalence rates and concluded from a dataset of 193 patients that among patients with both tinnitus and headaches, 45% suffered from migraines, 13% from tension headaches, and 6% from both. The authors postulated that both tinnitus and headache may be linked by common pathophysiological mechanisms without establishing this fact. While this study shows that headaches and tinnitus may be co-occurring (comorbid) diseases, it does not establish that tinnitus was the direct cause
://pubmed.ncbi.nlm.nih.gov/26583133/) establish that tinnitus may be comorbid (ie. co-occurring) with migraine headaches. The authors of the study sent questionnaires to patients with tinnitus and headaches to estimate prevalence rates and concluded from a dataset of 193 patients that among patients with both tinnitus and headaches, 45% suffered from migraines, 13% from tension headaches, and 6% from both. The authors postulated that both tinnitus and headache may be linked by common pathophysiological mechanisms without establishing this fact. While this study shows that headaches and tinnitus may be co-occurring (comorbid) diseases, it does not establish that tinnitus was the direct cause of migraine and/or tension headaches. Thus, the veteran's headache condition is less likely than not proximately due to service-connected bilateral tinnitus."

Based on this evidence the claim was denied in a November 2024 rating decision. The Veteran filed a higher-level review request in November 2024 indicating the private medical opinion was not acknowledged. The March 2025 rating decision acknowledged the private medical opinion and also noted that the Veteran had not participated in a toxic exposure risk activity (TERA). The RO favorably found that migraine headaches were a chronic condition subject to presumptive service connection. The RO indicated that that Dr. M. was a neuropsychologist while the VA examiner was a licensed medical doctor who was schooled in physiological conditions such as migraine. The examiner had expertise Dr. M. did not have. Thus, the VA medical opinion was more probative. 

In March 2025, a new examination request was submitted because there was conflicting information on the previous examination. The examiner of the new medical opinion opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner wrote:

"...There is no evidence to suggest that the Migraine including migraine variants condition is due to any one particular cause, namely the Tinnitus. The vast majority of Migraine including migraine variants are idiopathic with completely unexplained causes. The condition is occasionally vascular in nature, hormonal, genetic, medication related, due to OSA or CPAP use, due to brain lesions/masses or many other causes. I see no supportive documentation in the e-file or the evidence specifically noted above to support such a connection. Attributing the Migraine, including migraine variants, to Tinnitus without medical evidence is not objectively possible."

The Board acknowledges the Veteran's contentions that his migraines are secondary to his service-connected tinnitus. Reporting the symptom of pain is within realm of knowledge a lay person can report, and it be sufficient for the purpose of service connection. However, this report is not sufficient to establish a nexus between migraines and tinnitus. The Veteran does not have the requisite expertise. See Kahana v. Shinkseki, 24?Vet. App.?428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, the objective medical evidence of record answered this question. Service treatment records indicate the Veteran complained of headaches in service. The record does not included post-service treatment records that show treatment after service. The private medical opinion indicated that testing showed no other clinical causes for the Veteran's migraines. Thus, the neuropsychologist concluded that the Veteran's migraines were due to his tinnitus because it was due to some other definitive cause. The Board rejects this conclusion. A mere conclusion without an underlying rationale is of no probative value. Miller v. West, 11 Vet. App. 345 (1998). Etiology cannot be established based on a hypothesis. There must be an objective rationale to support the conclusion that the Veteran's migraines were secondary to tinnitus. As the VA examiner wrote, the Veteran's migraines and tinnitus may be comorbid but simultaneous occurrence does not conclude that one condition caused another. The VA examiner used medical literature to explain and support the conclusion reached. The Board finds the VA medical opinion to be probative. 

Accordingly, the criteria for entitlement to service connection for migraine headaches have not been established, either through medical or lay evidence. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the persuasive weight of the evidence is against the claim of entitlement to service connection for migraine headaches, that doctrine is not applicable. 38?U.S.C. §?5107(b); 38?C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53-56 (1990).

 

MICHAEL MARTIN

Veterans Law Judge

Board
 to be probative. 

Accordingly, the criteria for entitlement to service connection for migraine headaches have not been established, either through medical or lay evidence. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the persuasive weight of the evidence is against the claim of entitlement to service connection for migraine headaches, that doctrine is not applicable. 38?U.S.C. §?5107(b); 38?C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53-56 (1990).

 

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Harris

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.