MIGRAINE

A. DEAN · 2026 · Case ID: A26036330

GRANTED

Summary

The Veteran, a Veteran who served from February 1984 to February 1988, appeals the denial of an increased rating for his headache disability and entitlement to TDIU. The Veteran contends his headaches warrant a rating higher than the current 30 percent. The Board reviewed the Veteran's testimony from a November 2024 hearing, a January 2021 VA examination for headaches, and a March 2021 VA examination for his right eye condition. The Veteran described frequent, completely prostrating headache attacks that render him powerless and affect his depth perception, impacting his ability to work as an electrician. The VA examiner for headaches noted the impact on work but opined the condition did not meet the criteria for characteristic prostrating attacks. However, the Board found the Veteran's testimony, combined with the VA examinations, established that his headache condition meets the criteria for a 50 percent rating due to very frequent, completely prostrating, and prolonged attacks causing severe economic inadaptability. The Board also granted entitlement to TDIU, finding that the Veteran's combined service-connected disabilities, including the increased headache rating and severe visual impairment in his right eye, render him unemployable. Service connection for headaches is granted at 50 percent, and TDIU is granted.

Rationale

Veteran's testimony described frequent, completely prostrating attacks; Headaches impact ability to work as electrician due to depth perception issues; Evidence in approximate balance for 50% rating criteria

Special Benefit

TDIU

Diagnostic Code

8100

Docket No.

210624-168214

Full Decision Text

Citation Nr: A26036330
Decision Date: 04/20/26 Archive Date: 04/20/26

DOCKET NO. 210624-168214
DATE: April 20, 2026

ORDER

For the entire appeal period, a 50 percent rating for a headache disability is granted, subject to the laws and regulations governing the payment of monetary awards.

For the entire appeal period, entitlement to a total disability rating based on individual unemployability (TDIU) is granted, subject to the laws and regulations governing the payment of monetary awards.

FINDINGS OF FACT

1. The Veteran's headache disability includes very frequent, completely prostrating, and prolonged attacks, productive of severe economic inadaptability.

2. The Veteran's combined service-connected disabilities preclude him from securing and following a substantially gainful occupation.

CONCLUSIONS OF LAW

1. For the entire appeal period, the criteria for a 50 percent rating, but no higher, for a headache disability have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code (DC) 8100.

2. For the entire appeal period, the criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400, 4.16.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from February 1984 to February 1988.

In the June 24, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on November 25, 2024.

Therefore, the Board may only consider the evidence of record at the time of the March 2021 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review in June 2021, as well as any evidence submitted by the Veteran (or his representative) 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, which was subsequently subject to higher-level review 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.

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[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Applicable Law

Disability ratings are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

Where entitlement to compensation already has been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). If the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings, then separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings and is employed for initial or established ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

Entitlement to an evaluation of 50 percent, but no greater, for evaluation of headaches, is granted.

The Veteran contends his headache disability warrants a rating in excess of the currently assigned 30-percent disability rating. See, e.g., September 2020 VA 21-526EZ, Fully Developed Claim.

The Veteran's headache symptoms are rated under DC 8100 (migraine). See 38 C.F.R. § 4.124a, DC 8100. Under DC 8100, headaches are rated from 0 percent (noncompensable) to a maximum of 50 percent disabling. A noncompensable rating is warranted for headaches with less frequent attacks. A 10 percent rating is assigned for headaches with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent evaluation is warranted in cases of characteristic prostrating attacks occurring on an average of once a month over the last several months. Finally, the maximum 50 percent rating is assigned for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Id.

The rating criteria of Diagnostic Code 8100 are considered successive, meaning a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), defines prostration as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe headache attacks that typically produce extreme exhaustion or powerlessness.

The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the headache attack must render the Veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, regarding severe economic inadaptability, nothing in DC 8100 requires the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

In Holmes v. Wilkie, 33 Vet. App. 67 (2020), the Court held that DC 8100 contemplates all headache symptoms, and therefore, VA must consider all symptoms experienced due to headaches and then rate the symptoms based on the frequency, duration, and economic impact of those attacks. In rating headaches or migraines under DC 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

Turning to the evidence of record
for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

Turning to the evidence of record, the Veteran underwent a VA examination in January 2021 in conjunction with his claim for a higher rating. Although the examiner noted the Veteran's headache symptoms of constant head pain, pain on both sides of the head, pain worsened with physical activity, nausea, sensitivity to light, and sensitivity to sound, the examiner opined that the Veteran does not have characteristic prostrating attacks of migraine/non-migraine headache pain. The VA examiner noted the Veteran headache condition impacts his ability to work; she cited the Veteran's statement that he has "constant head pain on both sides of my head. It is severe and I have to lay in bed. I cannot work safely in my trade as an electrician. I can't function or focus at home or work with the headaches." See VA examination, January 2021.

During his November 2024 Board hearing, the Veteran testified that he has frequent, completely prostrating headache attacks that affect his ability to work as a certified electrician. The Veteran stated that when he gets "a severe headache you can't really, it's hard to function. I have to either sit down or lay down. I don't even want the TV on. I just need silence. And, and they can last a long time . . . It causes more, more problems with my, my depth perception problems." See Hearing Transcript, page 5, November 2024. he also testified that his headaches render him powerless in that it "depends on when, when it hits me where I'm at. What if I'm at Walmart? I got to get home. I got to try and get home. Driving is not easy. I've had my, my daughter actually drive me home before one time." Id.

When asked how his headaches impair his ability to work, the Veteran responded that his headaches further impair his depth perception, which is already limited due to his service-connected right eye double vision. "I've mentioned this to my previous boss in the past and he kind of give me a look like, 'That can be a little dangerous.' We had a discussion on in the past and I decided I, if I continue working in this field, I'm either going to hurt myself or somebody else." Id. at pages 6-8. The Veteran also reported his headache condition caused him to lose a job in a hotel doing maintenance. He stated that "headaches would come. I got to sit back. I got to sit back. And, you know, my boss would be like, "Why are you

sitting down? Why aren't you doing what needs to be done?"

Based on the Veteran's testimony, his medical records and the January 2021 VA examination, the evidence is at least in approximate balance that the Veteran's headache condition is manifested by very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability. Accordingly, entitlement to an initial increased rating of 50 percent for headaches secondary to service-connected eye disability is granted. The Board notes that the Veteran is now in receipt of a 50 percent rating for his post-concussive headaches, which is the highest schedular rating available under Diagnostic Code 8100.

Entitlement to a TDIU is granted.

Because the issue of entitlement to a TDIU has been raised as part of the underlying increased rating claim on appeal, the Board will address whether a total disability rating is warranted. See Rice v. Shinseki, 22 Vet. App. 447 (2009).

Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a Veteran is unable to secure and follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a).

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component is met when the Veteran is unemployed or marginally employed. Marginal employment generally shall be deemed to exist when the Veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a). Marginal employment includes employment in a protected environment, such as a family business or sheltered workshop, which involves a lower-income position that, due to the Veteran's service-connected disabilities, is shielded in some respect from competition in the employment market. LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024). Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a).

The non-economic component of the phrase "unable to secure and follow a substantially gainful occupation" includes consideration of the Veteran's history, education, skill, and training; whether the Veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the Veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Ray, 31 Vet. App. at 73.

The Board is not permitted to consider advancing age or a nonservice-connected disability when determining entitlement to a TDIU. 38 C.F.R. §§ 3.341(a), 4.16, 4.19.

A TDIU does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In this regard, entitlement to a TDIU is a legal determination, not a medical one. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Medical examiners may provide evidence regarding functional and occupational impairment, but the Board must decide whether a Veteran may "secure and follow a substantially gainful occupation" based on all evidence of record. See Delrio v. Wilkie, 32 Vet. App. 232, 243 (2019).

At the time of the rating decision on appeal, the Veteran's service-connected disabilities included right eye diplopia with strabismus, retinal detachment and

traumatic glaucoma (right eye disability) rated at 40 percent, and headaches associated with the right eye disability rated at 30 percent. The combined evaluation for compensation was 60 percent. This decision will increase the Veteran's combined evaluation to 70 percent.

During active service, the veteran worked in infantry and supply. After service he earned a degree as a certified electrician in 2004. Records show that he had jobs as a mechanic and worked in a hotel doing maintenance. A combination of the Veteran's hearing testimony and his medical records reflect that he was not employed during the appeal period. In this regard, his medical records show that in February 2019, he reported he had lost his job. See CAPRI, uploaded September 2020. During his November 2024 Board hearing, the Veteran testified he had not worked for at least 4 years. See Hearing Transcript, page 10, November 2024.

As noted earlier, during the Veteran's January 2021 VA examination for his headache disability, the examiner noted the Veteran's headaches impact his ability to work. The examiner noted the Veteran was currently unemployed but previously worked as an electrician, citing the Veteran's report that he "cannot work safely" as an electrician.

A March 2021 VA examination noted
not employed during the appeal period. In this regard, his medical records show that in February 2019, he reported he had lost his job. See CAPRI, uploaded September 2020. During his November 2024 Board hearing, the Veteran testified he had not worked for at least 4 years. See Hearing Transcript, page 10, November 2024.

A March 2021 VA examination noted that the Veteran's service-connected right eye disability results in severe visual impairment such that he is "practically blind." See VA examination, March 2021. The examiner noted that the eye impairment would make it "difficult to work with wiring/circuity due to not being able to separate wires." Id. A June 2021 VA examination reiterated that the Veteran was legally blind in his right eye. See VA examination, June 2021.

Given the significant limitations caused by the Veteran's vision issues and the severity of his headaches, as well as his education and prior work history primarily as an electrician or tradesman, the Board finds that the Veteran's service-connected disabilities render him unemployable. Accordingly, entitlement to a TDIU is granted for the entire appeal period.

A. Dean

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Newton

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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