MIGRAINE

Summary

The Veteran served from September 2006 to October 2011, including deployments to Iraq and Afghanistan, qualifying him as a Persian Gulf Veteran with presumed toxic exposure. He appeals the denial of service connection for a skin disorder and seeks service connection for migraine headaches, sinusitis, rhinitis, irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), and major depressive disorder. The Board granted service connection for migraine headaches, finding the evidence in equipoise and resolving doubt in the Veteran's favor based on a private medical opinion linking his migraines to particulate matter exposure during service. Service connection for sinusitis and rhinitis was granted presumptively under the PACT Act and 38 C.F.R. § 3.320, given his qualifying Southwest Asia service and documented gastrointestinal complaints during service. IBS and CFS were granted presumptively under 38 C.F.R. § 3.317 for Persian Gulf Veterans with qualifying service and diagnosed MUCMIs. Major depressive disorder was granted based on a private medical opinion finding it at least as likely as not incurred in service, supported by service treatment records noting adjustment disorder with anxiety and prescribed medication. The claim for skin disorder was remanded due to a duty to assist error; while a private opinion diagnosed atopic dermatitis and linked it to service, the Board found no service treatment record documentation and no presumptive basis for atopic dermatitis, necessitating a new medical opinion on etiology and service connection.

Rationale

Private medical opinion linked migraines to service; Service treatment records noted head pains during service; Evidence in equipoise, benefit of doubt applied

Full Decision Text

Citation Nr: A26036293
Decision Date: 04/20/26	Archive Date: 04/20/26

DOCKET NO. 250502-539974
DATE: April 20, 2026

ORDER

Entitlement to service connection for migraine headaches is granted.

Entitlement to service connection for sinusitis is granted. 

Entitlement to service connection for rhinitis is granted. 

Entitlement to service connection for irritable bowel syndrome (IBS) is granted.

Entitlement to service connection for chronic fatigue syndrome (CFS) is granted. 

Entitlement to service connection for major depressive disorder is granted. 

REMANDED

Entitlement to service connection for skin disorder, to include as due to exposure to toxins and fine particular matter, is remanded. 

FINDINGS OF FACT

1. Resolving all doubt in the Veteran's favor, his migraine headaches had their onset during his military service.

2.  The Veteran has a current diagnosis of sinusitis and presumed exposure to fine particulate matter based on his qualifying service in Iraq and Afghanistan.

3. The Veteran has a current diagnosis of rhinitis and presumed exposure to fine particulate matter based on his qualifying service in Iraq and Afghanistan.

4.  The Veteran has a current diagnosis of IBS and confirmed service in the Southwest Asia theater of operations during the Persian Gulf War.

5. The Veteran has a current diagnosis of CFS and confirmed service in the Southwest Asia theater of operations during the Persian Gulf War.

6. The Veteran's major depressive disorder had its onset during military service.

CONCLUSIONS OF LAW

1. The criteria for service connection for migraine headaches have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 

2. The criteria for service connection for sinusitis have been met.  38 U.S.C. 

§§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.320.

3. The criteria for service connection for rhinitis have been met.  38 U.S.C. 

§§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.320.

4. The criteria for service connection for IBS have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.317.  

5. The criteria for service connection for CFS have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.317.

6. The criteria for service connection for major depressive disorder have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 2006 to October 2011.  

This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision issued by a Department of Veteran Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA). 

In May 2025, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal, and requested the AMA direct docket review.  Under the rules of the AMA, the Board's review is limited to the evidence associated with the claims file as of the date of the April 2025 rating decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the Agency of Original Jurisdiction (AOJ) decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.  However, because the Board is remanding the service connection claim for a skin disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii). 

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303.  Generally, service connection requires three elements: (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
 Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii). 

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303.  Generally, service connection requires three elements: (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).  Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

VA has established certain rules and presumptions for chronic diseases, such as organic diseases of the nervous system, which VA has determined headaches to be.  See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).  With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes.  38 C.F.R. § 3.303(b).  If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim.  38 C.F.R. § 3.303(b).  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).

In August 2022, the President signed into law the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022, Pub. L. No. 117-168, 136 Stat. 1759 (2022) (commonly known as the "Honoring Our PACT Act of 2022" or "PACT Act"). In pertinent part, the PACT Act added presumptions for toxic exposure, to include burn pits and other toxins, for Veterans who served in specific locations, including Iraq (38 U.S.C. § 1119); added new presumptive conditions due to in-service exposure to burn pits and other toxins (38 U.S.C. § 1120(b)); added locations associated with service in the Persian Gulf theater (38 U.S.C. §§ 1112(c), 1116, 1117); and eliminated the manifestation period and the degree to which a qualifying chronic disability must manifest to be presumed as due to service in the Persian Gulf (38 U.S.C. § 1117). The PACT Act also established a lower threshold to obtain examinations or medical opinions under VA's duty to assist for veterans with presumed toxic exposures or who participated in toxic exposure risk activity (TERA) in service. 38 U.S.C. § 1168.    

Under 38 C.F.R. § 3.317, compensation is warranted for a Persian Gulf Veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2026.  38 C.F.R. § 3.317(a)(1)(i).  A "qualifying chronic disability" is a chronic disability resulting from either (1) an undiagnosed illness, or (2) a medically unexplained chronic multi-symptom illness (MUCMI) that is defined by a cluster of signs or symptoms (such as CFS, fibromyalgia, or functional gastrointestinal disorders).  38 C.F.R. § 3.317(a)(2)(i).  

There are two VA memoranda from December 2022 and January 2023.  The December 2022 VA memorandum states that the Veteran had military service that constitutes presumptive toxic exposure per 38 U.S.C. § 1119.  A January 2023 VA memorandum states the Veteran meets the definition of a Persian Gulf Veteran as specified by
 disability resulting from either (1) an undiagnosed illness, or (2) a medically unexplained chronic multi-symptom illness (MUCMI) that is defined by a cluster of signs or symptoms (such as CFS, fibromyalgia, or functional gastrointestinal disorders).  38 C.F.R. § 3.317(a)(2)(i).  

There are two VA memoranda from December 2022 and January 2023.  The December 2022 VA memorandum states that the Veteran had military service that constitutes presumptive toxic exposure per 38 U.S.C. § 1119.  A January 2023 VA memorandum states the Veteran meets the definition of a Persian Gulf Veteran as specified by 38 U.S.C. § 1117.  Specifically, the Veteran served in Iraq from March 28, 2008, through April 11, 2008, and in Afghanistan from September 30, 2008m through November 9, 2008; DoD military pay records show the Veteran received fire pay, imminent danger pay, and/or hazardous duty pay for service in Kuwait from April 2008 through October 2008; and DoD medals and awards records show the Veteran was awarded the Iraq Campaign Medal on December 12, 2008.  

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; 38 C.R.F. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

1. Entitlement to service connection for migraine headaches.

The Veteran contends he has a migraine headache disability due to his military service.  

A December 2024 private medical opinion from A.H. indicates that the Veteran has a diagnosis of migraines.  

The Veteran's service treatment records (STRs) show that on March 30, 2007, the Veteran had severe head pains that were assessed as part of an upper respiratory infection.  There is also a November 19, 2010, documentation of the Veteran's complaint of headache, nausea, diarrhea, and body aches for the past three days, accompanied with fevers.  

In the December 2024 private medical opinion, A.H. opined that the Veteran's headaches began during exposure to particulate matter.  Specifically, the Veteran's migraine symptoms began during his deployments to Iraq, and his testimony reveals that smells from his deployment were the first trigger to his migraine headaches.  While deployed, he began to experience headaches and blurred vision.  Consequently, A.H. opined it is at least as likely as not that the Veteran's migraine headaches were incurred in or are due to the result of his time in service.  

Given the aforesaid, the Board finds that the evidence of record is at least in equipoise as to whether the Veteran's currently diagnosed migraine headaches had their onset during his military service.  Therefore, resolving all doubt in his favor, the Board finds service connection for migraine headaches is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  

2. Entitlement to service connection for sinusitis.   

3. Entitlement to service connection for rhinitis.

Effective August 5, 2021, under 38 C.F.R. § 3.320(a), for Veterans with qualifying service in the "Southwest Asia theater of operations" during the Persian Gulf War, service connection may be presumed for certain listed chronic diseases associated with exposure to fine, particulate matter, even though there is no evidence of such disease during the period of military service. The list of diseases includes asthma, rhinitis, and sinusitis (to include rhinosinusitis), among others. 38 C.F.R. § 3.320(a)(2). In particular, service connection for the listed disease may be presumed under 38 C.F.R. § 3.320, if the listed disease becomes manifest to any degree (including noncompensable) at any time following separation from a qualifying period. Id. 

In a December 2024 disability benefits questionnaire, A.H. identified diagnoses of chronic sinusitis and rhinitis.

As previously explained, the record shows that the Veteran had service in Iraq from March 28, 2008, through April 11, 2008, and in Afghanistan from September 30, 2008, through November 9, 2008.  There is no affirmative evidence in the record establishing that sinusitis or rhinitis was not incurred or aggravated
 service connection for the listed disease may be presumed under 38 C.F.R. § 3.320, if the listed disease becomes manifest to any degree (including noncompensable) at any time following separation from a qualifying period. Id. 

In a December 2024 disability benefits questionnaire, A.H. identified diagnoses of chronic sinusitis and rhinitis.

As previously explained, the record shows that the Veteran had service in Iraq from March 28, 2008, through April 11, 2008, and in Afghanistan from September 30, 2008, through November 9, 2008.  There is no affirmative evidence in the record establishing that sinusitis or rhinitis was not incurred or aggravated during service or of a supervening event.  38 C.F.R. § 3.320(b).

Consequently, the Board finds service connection for sinusitis and rhinitis is warranted presumptively based on the Veteran's qualifying service in the Southwest Asia theater of operations during the Persian Gulf War.  38 C.F.R. § 3.320(a)(2). 

4. Entitlement to service connection for IBS.

Under 38 C.F.R. § 3.317, service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that manifested during active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War.  A "qualifying chronic disability" may result from (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness (MUCMI) defined by "a cluster of signs and symptoms"; or (3) any diagnosed illness determined by regulation that warrants a presumption of service connection. 38 C.F.R. § 3.317(a)(1).

An undiagnosed illness is defined as a disorder that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. The term MUCMI refers to a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.  38 C.F.R. § 3.317(a)(2)(ii).  Examples of MUCMIs include CFS, fibromyalgia, and functional gastrointestinal, to include IBS.  38 C.F.R. § 3.317(a)(2)(B).

As noted above, the Veteran had qualifying service in the Southwest Asia theater of operations during the Persian Gulf War. 

Turning to the medical evidence of record, the Veteran's STRs contain documentation of gastrointestinal complaints during service, including after his deployment in Southwest Asia.  There is a May 13, 2009, notation of gastroenteritis; an April 19, 2010, complaint of diarrhea for the past one week, and assessed as gastroenteritis; an April 27, 2010, notation of an assessment as gastroenteritis, and; a November 19, 2010, complaint of diarrhea, in addition to other symptoms, which was assessed as gastroenteritis.  As such, the record establishes that the Veteran experienced gastrointestinal issues during military service, to include after his return from his deployment in Southwest Asia.  

The private examiner, A.H., diagnosed the Veteran with IBS in December 2024.  A.H. explained that the Veteran's symptoms included stomach problems ranging from constipation and change of bowel habits with symptoms of diarrhea.  Therefore, as the Veteran has a diagnosis of IBS and qualifying service in the Southwest Asia theater of operations during the Persian Gulf War, entitlement to service connection for IBS is granted pursuant to 38 C.F.R. § 3.317.

5. Entitlement to service connection for CFS. 

The Veteran contends he is entitled to service connection for CFS.

The Veteran has a diagnosis of CFS based on the December 2024 examination report completed by the private medical examiner, A.H.   

As the Veteran has a diagnosis of CFS and qualifying service in the Southwest Asia theater of operations during the Persian Gulf War, entitlement to service connection for CFS is granted pursuant to 38 C.F.R. § 3.317.

6. Entitlement to service connection for major depressive disorder.

The Veteran contends he has a psychiatric disability due to military service. 

In December 2024, private medical examiner, A.H., diagnosed major depressive disorder. 

The Veteran's STRs document a May 13, 2009, entry, wherein the Veteran was noted to have adjustment disorder with anxiety.  Additionally, Doxepin is listed as an active medication, which is often used to treat major depressive disorder, anxiety disorders, and insomnia.  

Private medical examiner, A
FS and qualifying service in the Southwest Asia theater of operations during the Persian Gulf War, entitlement to service connection for CFS is granted pursuant to 38 C.F.R. § 3.317.

6. Entitlement to service connection for major depressive disorder.

The Veteran contends he has a psychiatric disability due to military service. 

In December 2024, private medical examiner, A.H., diagnosed major depressive disorder. 

The Veteran's STRs document a May 13, 2009, entry, wherein the Veteran was noted to have adjustment disorder with anxiety.  Additionally, Doxepin is listed as an active medication, which is often used to treat major depressive disorder, anxiety disorders, and insomnia.  

Private medical examiner, A.H., explained that the Veteran was prescribed medication as a result of his post-deployment examination.  A.H. opined that the Veteran's symptoms started while in service and have continued since that time; as such, it is at least as likely as not that his current mental health disorder was incurred in service.  A.H. reviewed the Veteran's STRs, took into consideration his lay statements, and reconciled the opinion with supported medical facts from the Veteran's claims file.  Thus, the Board affords the favorable opinion probative weight.  Notably, there is no competent opinion to the contrary.

As a result, the Board finds the Veteran's currently diagnosed major depressive disorder had its onset during his military service.  As such, service connection for major depressive disorder is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  

REASON FOR REMAND

Entitlement to service connection for skin disorder, to include as due to exposure to toxins and fine particular matter.

The Veteran contends he has dermatitis related to a deployment.

In December 2024, a private medical examiner, A.H., diagnosed atopic dermatitis. 

Upon review of the Veteran's STRs, there is no documentation of complaints referrable to the skin, to include dermatitis.

As previously explained, a December 2022 VA memorandum states the Veteran had military service that constitutes presumptive toxic exposure per 38 U.S.C. 

§ 1119.  A January 2023 VA memorandum states that the Veteran meets the definition of a Persian Gulf Veteran as specified by 38 U.S.C. § 1117. 

Although A.H. provided a favorable opinion linking the Veteran's atopic dermatitis to his service, there is no rationale in support of the opinion other than a supposed "presumptive" link to hazardous exposure.  In this regard, atopic dermatitis is not a disease for which presumptive service connection is provided.  

Nevertheless, the Board finds that, based on the Veteran's reported symptoms and his presumed exposures, the failure to obtain a medical opinion as to the etiology of any current skin disorder constitutes a pre-decisional duty to assist error that must be corrected on remand.  

The matter is REMANDED for the following action:

Forward the record, to include a copy of this Remand, to an appropriate clinician for an opinion as to the nature and etiology of any current skin disorder.  

Following a review of the record, the clinician is asked to provide an opinion as to whether it is at least as likely as not that a current skin disorder began in or is otherwise related to the Veteran's military service, to include all conceded toxic exposure risk activities.

The clinician must not rely solely on the absence of diagnosis or treatment in service, or the lack of medical documentation thereafter, as the basis for a negative opinion.

A rationale should be provided for any opinion offered. 

 

M. M. Celli

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Smith, Associate 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. 


 C.F.R. § 20.1303.