HEADACHES

Summary

The Veteran served on active duty from July 1999 to November 2002. This case comes before the Board of Veterans' Appeals following a Joint Motion for Remand from the United States Court of Appeals for Veterans Claims, vacating a prior Board decision. The Veteran sought an increased rating for service-connected migraine headaches, currently rated at 10 percent disabling, and service connection for left hip, right hip, cervical spine, and lumbar spine disabilities. Regarding the migraine headaches, the Board reviewed the criteria under Diagnostic Code 8100, noting that a 30 percent rating requires prostrating attacks averaging once a month, and a 50 percent rating requires very frequent, prolonged attacks causing severe economic inadaptability. The Board found that the Veteran's May 2022 VA examination indicated less frequent prostrating attacks than required for a 30 percent rating, and that the Veteran's need for OTC medication and rest did not meet the criteria for a higher rating. The Board acknowledged the Veteran's competency to report symptoms but accorded greater weight to the medical findings. The appeal for migraine headaches was denied. The Board remanded the hip and spine claims, citing inadequate VA opinions from the May 2022 examination. The Court noted the examiner's conclusory statements and failure to analyze the significance of normal separation examinations. The remand requires new examinations for the hip and spine conditions, with specific instructions for the examiner to address nexus, secondary causation, and potential functional impairment.

Rationale

Migraine headaches rated under DC 8100.; 10% rating for attacks averaging one in two months.; 30% rating requires attacks averaging once a month.; VA exam showed less frequent prostrating attacks.; Need for OTC medication and rest did not meet higher criteria.

Full Decision Text

Citation Nr: A26035299
Decision Date: 04/15/26	Archive Date: 04/15/26

DOCKET NO. 230301-328788
DATE: April 15, 2026

ORDER

Entitlement to a disability rating in excess of 10 percent for service-connected migraine headaches is denied. 

REMANDED

Entitlement to service connection for a left hip disability is remanded.   

Entitlement to service connection for a right hip disability is remanded. 

Entitlement to service connection for a cervical spine disability is remanded. 

Entitlement to service connection for a lumbar spine disability is remanded.

FINDING OF FACT

The Veteran's service-connected migraine headaches are manifested by no more than characteristic prostrating attacks averaging one in two months over the last several months.

CONCLUSION OF LAW

The criteria for a disability rating in excess of 10 percent for service-connected migraine headaches have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.124a, Diagnostic Code 8100.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from July 1999 to November 2002. 

This matter is before the Board of Veterans' Appeals (Board) on appeal of July 2022 and November 2022 rating decisions of the Department of Veterans Affairs (VA).

In a December 2024 decision, the Board denied, in part, the issues on appeal.  The Veteran appealed the Board decision to the United States Court of Appeals for Veterans Claims (Court).  In a Joint Motion for Remand (JMR), dated in October 2025, the Court vacated the Board's decision and remanded the claim to the Board. Hence, this matter is once again before the Board for appellate consideration.

Increased Rating Claim

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities.  Ratings are based on the average impairment of earning capacity.  Individual disabilities are assigned separate diagnostic codes.  See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.  In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal.  See generally Fenderson v. West, 12 Vet. App. 119 (1999).  Where entitlement to compensation has already been established, and an increase in the disability rating is at issue, the present level of disability is of primary concern.  Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings.  See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2.  Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings.  The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim.  See generally Hart v. Mansfield, 21 Vet. App. 505 (2007).

Where there is a question as to which of two evaluations shall be applied, 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.  In every instance where the rating schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.  38 C.F.R. § 4.31.

The Veteran seeks a higher evaluation for her service-connected migraine headaches, which is currently evaluated as 10 percent disabling pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 8100.  Under Diagnostic Code 8100, headaches with characteristic prostrating attacks averaging one in two months over the last several months are rated as 10 percent disabling.  A 30 percent disability rating is warranted for headaches with characteristic prostrating attacks occurring on an average once a month over the last several months.  Headaches manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent disability rating.  38 C.F.R. § 4.124a, Diagnostic Code 8100.  Diagnostic
 her service-connected migraine headaches, which is currently evaluated as 10 percent disabling pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 8100.  Under Diagnostic Code 8100, headaches with characteristic prostrating attacks averaging one in two months over the last several months are rated as 10 percent disabling.  A 30 percent disability rating is warranted for headaches with characteristic prostrating attacks occurring on an average once a month over the last several months.  Headaches manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent disability rating.  38 C.F.R. § 4.124a, Diagnostic Code 8100.  Diagnostic Code 8100 contains successive criteria throughout the regulation.  Johnson v. Wilkie, 30 Vet. App. 245 (2018).  Thus, to satisfy the 50 percent criteria, the headaches must be both "very frequent" and "prolonged."  Id.

The rating criteria do not define "very frequent" or "prolonged."  However, the Court has held that "the phrase 'very frequent' connotes a frequency greater than once a month."  Id. at 253.

The rating criteria do not define "severe economic inadaptability;" however, nothing in Diagnostic Code 8100 requires the claimant to be completely unable to work in order to qualify for a 50 percent rating.  See Pierce v. Principi, 18 Vet. App. 440 (2004).  The Secretary has conceded that the term "productive of economic inadaptability" could be read as either "producing" or "capable of producing."  Id.

The Veteran was afforded a VA headaches examination in May 2022. The Veteran noted that the pain level ranged from 4-8 out of 10, and she took over the counter medication and rested in a dark room for relief.  Upon examination, it was noted that the Veteran experienced headache pain, described as aching pressure   It was noted that she was sensitive to light and sound.  The pain was located on either the right or left frontal area and lasted less than 1 day.  Less frequent prostrating attacks of pain were noted.  The prostrating and prolonged attacks were not production of severe economic inadaptability.

In the October 2025 JMR, the Court indicated that the Board, in its December 2024 decision, did not address that the Veteran had noted taking over the counter medication for her condition, and that she would rest in a dark room for relief, as the Board had noted that there has been no allegation or evidence that the Veteran's medication has ameliorated her headache disability in terms of symptoms, severity, or frequency during the relevant period such that there are ameliorative effects that require discounting.  See Jones v. Shinseki, 26 Vet. App. 56, 61 (2012).

In this case, the Board acknowledges the Veteran's symptoms, the need for over-the-counter (OTC) medication and the need to rest.  As noted above, under Diagnostic Code 8100, the phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under Code 8100 to describe the nature and severity of migraines, but it is not defined in the regulation.  Pursuant to Dorland's Illustrated Medical Dictionary, 1507 (33rd ed. 2020), 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.  Johnson, 30 Vet. App. at 253. In nonmedical terms, prostrating is defined as lying flat or at full length, to reduce to physical weakness or exhaustion, or to reduce to helplessness.

Regarding the medical evidence, the May 2022 VA examination report did not reveal that the characteristics of prostrating attacks warranted a 30 percent rating.  The 2022 examination report shows that the Veteran had prostrating attacks occurring less frequently.  The currently assigned 10 percent rating specifically contemplates characteristic prostrating attacks as described.  Further, the frequency of the prostrating attacks were not noted to occur on an average of once a month. 

Thus, based on the cumulative review of the evidence, to include the Veteran's statements of the need for OTC medication and rest, and the medical evidence, the Board finds that the criteria for the next higher rating of 30 percent have not been met.  The record does not show that the criteria of headaches with characteristic prostrating attacks occurring on an average once a month over the last several months are met at this time.

The
 2022 examination report shows that the Veteran had prostrating attacks occurring less frequently.  The currently assigned 10 percent rating specifically contemplates characteristic prostrating attacks as described.  Further, the frequency of the prostrating attacks were not noted to occur on an average of once a month. 

Thus, based on the cumulative review of the evidence, to include the Veteran's statements of the need for OTC medication and rest, and the medical evidence, the Board finds that the criteria for the next higher rating of 30 percent have not been met.  The record does not show that the criteria of headaches with characteristic prostrating attacks occurring on an average once a month over the last several months are met at this time.

The Board acknowledges the Veteran is competent to report observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  She is not, however, competent to identify a specific level of disability.  The medical findings adequately address the criteria under which the Veteran's migraine headaches are evaluated and clearly demonstrate the degree of impairment over the appeal period.  The Board accords these findings greater weight than the Veteran's complaints as to any increased symptomatology.  See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991).

Based on the foregoing, as to entitlement to a disability rating in excess of 10 percent for migraine headaches, the benefit of the doubt doctrine does not apply.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; See, e.g., Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021); Mattox v. McDonough, 56 F.4th 1369, 1378-79 (Fed. Cir. 2023). The appeal must be denied.

Other considerations

Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record.  See Doucette v. Shulkin, 28 Vet. App. 366 (2017). 

Specifically, the Board acknowledges that in Rice v. Shinseki, 22 Vet. App. 447 (2009), it was held that a claim for a total disability rating based on individual unemployability (TDIU) is part and parcel of an increased rating claim when such is raised by the record.  In this case, the Veteran has not contended, and there is no evidence of record, showing that her service-connected disability renders her unemployable.  The May 2022 VA examination report did not show that the Veteran's disability limited her ability for employment.  Accordingly, a TDIU claim has not been raised, and no action pursuant to Rice is necessary.

REASONS FOR REMAND

For the claimed left hip, right hip, cervical spine and lumbar spine disabilities on appeal, the Court indicated in its JMR that the Board erred when it relied on inadequate VA opinions.  The Court noted that for the issue of service connection for the claimed disabilities, the May 2022 VA examiner's opinions were conclusory as it was noted that the Veteran's current was not "due to any remote, isolated pain/strains she may have incurred while in military service as those pain/strains would have resolved years ago."  The VA examiner merely noted a normal examination of the Veteran's conditions.  The Court stated that the VA examiner provided no specific analysis as to why he found it significant that the Veteran had normal separation examinations.

Based on the foregoing, and consistent with the October 2025 Court Order, the Board finds that this matter should be remanded to obtain the additional medical evidence necessary to adequately address the claim.

The matters are REMANDED for the following action:

1. Schedule the Veteran for the examinations by a qualified examiner (or examiners) for the claimed left hip, right hip, cervical spine and lumbar spine disabilities on appeal. Do not use the VA examiner that provided the May 2022 VA medical opinions.

(a.) The entire electronic claims file must be reviewed by the examiner.  

(b.) The examiner is to conduct all necessary tests and studies. 

2. The examiner is advised a "disability" is not necessarily a formally diagnosable medical or physical condition-rather, it is the functional impairment associated with the symptoms of a medical or physical condition. Therefore, if the examiner cannot diagnose a disease, disorder, injury, or condition causing the Veteran's symptoms, they should describe, assess, and explain the Veteran's symptoms in detail, and identify any resulting functional impairment pertaining to the Veteran's potential earning capacity in a civil occupation. 

3. For any disability, disease, disorder, injury, or
 the May 2022 VA medical opinions.

(a.) The entire electronic claims file must be reviewed by the examiner.  

(b.) The examiner is to conduct all necessary tests and studies. 

2. The examiner is advised a "disability" is not necessarily a formally diagnosable medical or physical condition-rather, it is the functional impairment associated with the symptoms of a medical or physical condition. Therefore, if the examiner cannot diagnose a disease, disorder, injury, or condition causing the Veteran's symptoms, they should describe, assess, and explain the Veteran's symptoms in detail, and identify any resulting functional impairment pertaining to the Veteran's potential earning capacity in a civil occupation. 

3. For any disability, disease, disorder, injury, or condition, the examiner should make a finding as to whether it is approximately as likely as not it had its onset in, or is otherwise etiologically related to, the Veteran's military service.

4. Connection to service may be secondary rather than direct-that is, if one disability causes or aggravates (i.e., makes more severe) another disability, if the first primary disability is connected to service, so is the second disability. 

(a.) If an examiner finds a direct service connection between any but not all of the Veteran's claimed hip and spine disabilities, they should expressly address the possibility of secondary service connection for those disabilities not directly connected to service.

(b.) Secondary causation and secondary aggravation should each be independently addressed.

5. If the examiner concludes there is no connection between the Veteran's service and his claimed disability, they should, to the extent practicable, identify alternative explanations for the disability, disease, disorder, injury, condition, or symptoms in question.

6. All opinions, findings and conclusions should be supported by a complete rationale, including references to patient history, evidence in the record, medical knowledge, publications, or other sources of information relied on in the examiner's analysis. 

7. When adjudicating entitlement to service connection, only a "but-for" causal relationship between an in-service disease or injury and a present disability is required. Thus, the in-service disease or injury need not be the sole cause or even the main cause of the present disability, provided it was a substantial and necessary factor in the development of the present disability.  

8. When adjudicating entitlement to service connection, the Veteran is entitled to a favorable finding when positive evidence is at least "approximately balanced" with or "nearly equal" to the negative evidence on any material issue, thereby triggering the benefit-of-the-doubt doctrine. 

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9. If any of the requested opinions or responses cannot be provided without resorting to speculation, the examiner should explain why this is so.

 

 

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Evans, A-L

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.