MIGRAINE

B.T. KNOPE · 2026 · Case ID: A26035224

MIXED

Summary

The Veteran, an Air Force Veteran who served from September 1989 to March 1992, appeals the denial of service connection for migraines, lumbar degenerative disc disease, bilateral lower extremity radiculopathy, and bilateral hip strain. The Veteran also sought an increased rating for her service-connected bilateral knee strain. The Board granted service connection for migraines, finding they began during active service and continued post-service, establishing a direct link. For lumbar degenerative disc disease and bilateral lower extremity radiculopathy, the Board found service connection warranted on a secondary basis, concluding these conditions were proximately due to or the result of her service-connected bilateral knee disability, based on credible testimony from the Veteran about her limping and subsequent back pain. However, the Board denied service connection for the bilateral hip strain, finding no evidence of in-service onset, continuity of symptoms, or a secondary link to the knee disability, and attributing the hip pain to radiculopathy from the lumbar spine. The Board noted that while the Veteran's hip and low back conditions were not diagnosed during service, her migraines were noted at separation and supported by post-service treatment records, establishing continuity. The Board also found the Veteran's testimony regarding her back pain and limping credible and probative.

Rationale

Onset during active service; Continuity of symptoms established; Direct service connection warranted

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210806-177214

Full Decision Text

Citation Nr: A26035224
Decision Date: 04/15/26 Archive Date: 04/15/26

DOCKET NO. 210806-177214
DATE: April 15, 2026

ORDER

Entitlement to service connection for migraines is granted.

Entitlement to service connection for lumbar degenerative disc disease, to include as secondary to bilateral knee strain, is granted.

Entitlement to service connection for right lower extremity radiculopathy is granted.

Entitlement to service connection for left lower extremity radiculopathy is granted.

Entitlement to service connection for left hip strain, to include as secondary to bilateral knee strain, is denied.

Entitlement to service connection for right hip strain, to include as secondary to bilateral knee strain, is denied.

FINDINGS OF FACT

1. The Veteran's migraine disorder is etiologically related to service.

2. The Veteran's lumbar degenerative disc disease has been worsened beyond its natural progression by service-connected bilateral knee strain.

3. The Veteran's right lower extremity radiculopathy is proximately due to lumbar degenerative disc disease.

4. The Veteran's left lower extremity radiculopathy is proximately due to lumbar degenerative disc disease.

5. The Veteran's claimed left hip condition is not proximately due to service-connected disability.

6. The Veteran's claimed right hip condition is not proximately due to service-connected disability.

CONCLUSIONS OF LAW

The criteria for entitlement to service connection for migraines have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

1. The criteria for entitlement to service connection for lumbar degenerative disc disease, to include as secondary to bilateral knee strain, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

2. The criteria for entitlement to service connection for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. The criteria for entitlement to service connection for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

4. The criteria for entitlement to service connection for left hip strain have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3.310.

5. The criteria for entitlement to service connection for right hip strain as have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served honorably in the United States Air Force from September 1989 to March 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 2021 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO).

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on March 21, 2025. Therefore, the Board may only consider the evidence of record at the time of the June 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302 (a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302 (a), 20.801.

Service Connection

Under the relevant laws and 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(b); Holton v.
hearing. 38 C.F.R. § 20.302 (a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302 (a), 20.801.

Service Connection

Under the relevant laws and 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(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), 3.304, 3.307, 3.309, 3.310. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995).

A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310.

1. Entitlement to service connection for migraines.

2. Entitlement to service connection for lumbar degenerative disc disease.

3. Entitlement to service connection for right lower extremity radiculopathy.

4. Entitlement to service connection for left lower extremity radiculopathy.

5. Entitlement to service connection for left hip strain.

6. Entitlement to service connection for right hip strain.

The Veteran contends that her migraines, low back disability, and bilateral hip condition are related to service-connected disability. After a review of the evidence, the Board finds that service connection is warranted for migraines as well as lumbar spine degenerative disc disease and associated lower extremity radiculopathy. However, service connection is not warranted for a bilateral hip condition.

As an initial matter, the Veteran does not contend that any of the claimed conditions began during active service or shortly thereafter. However, she did report frequent or severe headaches and recurrent back pain upon separation. The examiner noted frequent headache secondary to sinus problems since age 15. In this regard, the Board notes that a veteran will be considered to have been in sound condition when examined and accepted for service, except as to disorders noted on entrance into service, or when clear and unmistakable evidence demonstrates that the disability existed prior to service and was not aggravated by service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). Here, severe headaches were not noted upon entrance and the clinician's note at separation does not reach the high level set by the clear and unmistakable standard. Hence, a preexisting headaches disorder is not supported by the record.

On the other hand, the clinician noted that the Veteran had back pain on a single occasion during pregnancy. A review of service treatment records confirms this observation. Hence, the clinical evidence does not show a chronic back condition during active service. In addition, service treatment records do not show diagnosis, treatment, or complaints of a hip condition and the Veteran does not contend that her hip condition began during active service.

The Veteran was diagnosed with lumbar degenerative disc disease with bilateral lower extremity radiculopathy and a bilateral hip strain in 2018. A currently diagnosed hip condition is not contained in the record. The June 2021 VA examination notes a diagnosis of migraines in 1991.

Migraines

The Veteran's initial claim asserts a theory of secondary service connection: that her migraines are related to her service-connected psychiatric disorder. Accordingly, the record has been developed with this theory of service connection in mind. However, the clinical evidence strongly suggests that her migraines began during active service.

As mentioned, the Veteran was presumed sound at entrance to service and reported severe and frequent
condition began during active service.

Migraines

As mentioned, the Veteran was presumed sound at entrance to service and reported severe and frequent headaches at separation. Thus, the evidence suggests the onset of headaches during active service. Moreover, post-service treatment records support the onset of a headache disorder during active service. In July 2019, the Veteran's private clinician noted that her chronic migraines had been diagnosed 20 years prior. In addition, the June 2021 VA examiner noted an onset of 1991, prior to separation from active service.

The evidence also firmly establishes that the Veteran has suffered from chronic migraines since the time of onset. A history of migraines was noted during treatment in both June 2007 and September 2012. Hence, a continuity of symptoms since service has been established.

Based on the foregoing, the Board finds that the evidence supports finding a link between the Veteran's current migraine disorder and active service. The evidence show that the condition began during active service and has continued to the present day.

To summarize, the evidence shows that the Veteran's migraine disorder is attributable to active service. Accordingly, service connection is warranted on a direct basis. The claim is granted.

Low Back, Neuropathy and Bilateral Hip Complaints

As for the Veteran's back and hip complaints, the clinical evidence does not show diagnosis, treatment, or complaints of any hip or lower back condition during service or until many years after. Indeed, treatment for low back and hip pain is not of record until June 2012, where she reported a 2 year history of low back pain. In July 2012, pelvic abnormalities were noted to include a positive piriformis test. Treatment was isolated to pain in the low back that radiated down through the hips. A hip condition was not diagnosed at that time. In addition, the Veteran testified at her Board hearing that her low back and hip pain began in 2009 after a fall. Hence, based on the medical and lay evidence, a continuity of symptoms since service has not been established.

As to nexus, the Board observes that the Veteran has not been afforded a VA examination specifically to address service connection for a low back or hip condition on a direct basis. However, given the lack of any in-service incident, illness, or injury to which such disabilities may be linked combined with the absence of evidence of symptoms for many years after separation from active service, the duty to assist did not require such development prior to issuance of the rating decision on appeal. 38 C.F.R. § 3.159(c) (4) (i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the evidence does not show the onset of the Veteran's low back or hip conditions until many years after separation from active service. As such, based on the evidence of record, the Board finds that a nexus has not been established for a migraines on a direct basis.

As to service connection on a secondary basis, the Veteran was afforded a VA examination in September 2018. The examiner opined that the Veteran's hip and low back conditions were less likely than not related to her service-connected knee condition. The examiner opined that the Veteran's low back and hip conditions were not medically related to her knee condition. The hip and low back are separate entities entirely from the knee and unrelated to it. The medical literature does not support a medical relationship. Although the examiner checked the no box when asked if either condition was aggravated beyond its natural progression due to the service-connected knee, the same causation rationale was simply cut and pasted. In essence, the issue of aggravation was not answered.

At a subsequent VA examination in June 2021, the examiner noted that the Veteran's hip pain was not attributable to any actual diagnosable hip condition. Unfortunately, the June 2021 examiner also denied a causal nexus without rendering an opinion regarding aggravation. Hence, VA has yet to obtain an adequate examination addressing whether the Veeran's claimed conditions have been aggravated by her service-connected bilateral knee disability. Fortunately, the Board finds that remand for another examination is not necessary.

At the
checked the no box when asked if either condition was aggravated beyond its natural progression due to the service-connected knee, the same causation rationale was simply cut and pasted. In essence, the issue of aggravation was not answered.

At the Veteran's Board hearing, she reported that she utilizes a cane to assist with ambulation because she limps due to her knee disability. As a result, she has tremendous back pain after only 30 minutes of walking that radiates down through her hips. In this regard, the Board finds that Veteran's testimony credible and highly probative. She is competent to testify to that which is actually observed and is within the realm of personal knowledge, such as the onset of low back pain after limping for periods of time. See Layno v. Brown, 6 Vat. App. 465 (1994). Hence, the Board finds that her low back degenerative disc disease has been worsened by her bilateral knee disability.

With regard to the Veteran's claimed hip disorder, the evidence suggests that the pain she feels in her hip is actually radiculopathy radiating down from her low back disability. Hence, service connection is not warranted for a bilateral hip condition. However, the General Rating Formula for Diseases and Injuries of the Spine stipulates that any associated objective neurologic abnormalities are to be rated separately from orthopedic manifestations of the spine disability under an appropriate diagnostic code. 38 C.F.R. § 4.71a, Note (1). Accordingly, entitlement to service connection for bilateral lower extremity radiculopathy associated with lumbar degenerative disc disease is warranted.

To summarize, the evidence does not suggest that the Veteran's claimed hip condition is related to service or proximately due to her service-connected bilateral knee disability. More accurately, the evidence shows that the Veteran's low back disability and associated bilateral lower extremity radiculopathy is proximately due to her bilateral knee condition. To that extent, the claim is granted. 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.

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ballinger, Daniel

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