MIGRAINE

J. JACK · 2026 · Case ID: A26036798

MIXED

Summary

The Veteran, an Army Veteran who served from September 1955 to August 1958, appeals decisions denying service connection for an acquired psychiatric disorder (including PTSD, anxiety, and depression) secondary to TBI, an increased rating for residuals of TBI, and entitlement to TDIU. The Board granted an initial 50 percent rating for migraines, finding the Veteran's frequent, prostrating headaches with hypersensitivity to light and sound resulted in severe economic inadaptability, approximating the maximum rating criteria. The Board found the VA examinations for migraines adequate and consistent with the rating criteria. However, the claims for acquired psychiatric disorder, residuals of TBI, and TDIU were remanded due to pre-decisional duty to assist errors. Specifically, the VA examination for the psychiatric disorder provided an opinion regarding migraines rather than the psychiatric condition, and the TDIU claim was not adjudicated by the agency of original jurisdiction. The Board noted that any evidence not considered due to submission deadlines would be reviewed by the agency of original jurisdiction during the remand proceedings.

Rationale

Frequent prostrating and prolonged headaches; Hypersensitivity to light and sound; Severe economic inadaptability

Service Branch

ARMY

Special Benefit

TDIU

Diagnostic Code

8100

Docket No.

251211-623239

Full Decision Text

Citation Nr: A26036798
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 251211-623239
DATE: April 21, 2026

ORDER

An initial 50 percent rating for migraines is granted.

REMANDED

Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), anxiety, and depression, to include as secondary to residuals of traumatic brain injury (TBI), is remanded.

An initial compensable rating for residuals of TBI is remanded.

A total disability rating due to individual unemployability (TDIU) is remanded.

FINDING OF FACT

The Veteran's migraines manifested by completely prostrating and prolonged attacks of migraine pain resulting in severe economic inadaptability throughout the appeal period.

CONCLUSION OF LAW

The criteria for an initial 50 percent rating for migraines have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8100.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1955 to August 1958 in the United States (U.S.) Army.

The rating decisions on appeal were issued in May 2025 and November 2025 and constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In October 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a June 2024 decision for the issues of entitlement to increased ratings for migraines and residuals of TBI. Although the Veteran initially requested Higher-Level Review when submitting the October 2024 VA Form 20-0996, Decision Review Request: Higher-Level Review, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. In May 2025, the agency of original jurisdiction (AOJ) issued the decision on appeal, and denied the claims based on the evidence of record at the time of that decision.

In May 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a May 2025 decision for the issue of service connection for an acquired psychiatric disorder, to include PTSD, anxiety, and depression. Although the Veteran initially requested Higher-Level Review when submitting the May 2025 VA Form 20-0996, Decision Review Request: Higher-Level Review, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. In November 2025, the AOJ issued the decision on appeal, and denied the claim based on the evidence of record at the time of that decision.

In the December 11, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the May 2025 decision on appeal for the issues of entitlement to increased ratings for migraines and residuals of TBI and at the time of the November 2025 decision on appeal for the issue of service connection for an acquired psychiatric disorder, to include PTSD, anxiety, and depression, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims of service connection for an
Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

However, because the Board is remanding the claims of service connection for an acquired psychiatric disorder, to include PTSD, anxiety, and depression, entitlement ot an increased rating for residuals of TBI, and entitlement to a TDIU, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Increased Rating for Migraines

The Veteran contends that a higher rating is warranted for his service-connected migraines.

Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular DC, the higher rating is assigned if the disability more nearly approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

The Veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where, as here, 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. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505, 510 (2007).

The Veteran is assigned a 30 percent rating for his service-connected migraines prior to May 6, 2025, and a 50 percent rating thereafter under 38 C.F.R. § 4.124a, DC 8100. Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100.

The rating criteria of DC 8100 are considered successive, meaning that 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). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252.

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. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), 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.

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 migraines 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. (internal citation omitted). 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 that the claimant be completely unable to work to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

DC 8100 contemplates all migraine symptoms. Therefore, to evaluate migraines under DC 8100, VA must consider all symptoms experienced due to migraine attacks and then rate the symptoms based on the frequency, duration, and economic impact of those attacks. Holmes v. Wilkie, 33 Vet. App. 67 (2020).

After review of the record, the Board finds that the Veteran's migraines resulted in severe economic inadaptability contemplated by the maximum 50 percent rating throughout the appeal period.

The Veteran was afforded a VA examination in May 2024. The Veteran reported that since his in-service TBI, he has experienced severe migraine headaches of intensity 10 out of 10 with nausea and hypersensitivity to light and sound once per week. The examiner found that the Veteran experiences pulsating or throbbing head pain on both sides of the head lasting less than one day, and other symptoms including nausea, sensitivity to light, and sensitivity to sound. The examiner also found that the Veteran has characteristic prostrating attacks of migraine/non-migraine headache pain greater than once per month; however, the Veteran did not have completely prostrating and prolonged attacks of migraine/non-migraine pain. Regarding functional impact, the examiner found that the Veteran has lost more than 5 weeks of work time in the last 12 months and his frequent prostrating and prolonged headaches associated with hypersensitivity to light and hypersensitivity to noise can impact his ability to work.

The Veteran was afforded another VA examination in May 2025. The Veteran again reported that since his in-service TBI, he has experienced severe migraine headaches of intensity 10 out of 10 with nausea and hypersensitivity to light and sound once per week. The examiner found that the Veteran does not experience headache pain; however, he experiences other symptoms including nausea, sensitivity to light, and sensitivity to sound. The examiner also found that the Veteran has characteristic and completely prostrating attacks of migraine/non-migraine headache pain greater than once per month. Regarding functional impact, the examiner found that the Veteran has lost 1-2 weeks of work time in the last 12 months and his frequent prostrating and prolonged headaches associated with hypersensitivity to light and hypersensitivity to noise can impact his ability to work.

Based on the foregoing, the Board finds that the Veteran's migraine symptoms have been consistent throughout the appeal period. The Veteran experienced frequent prostrating and prolonged headaches associated with hypersensitivity to light and sound impacting his ability to work. The Board finds that this approximates the severe economic inadaptability contemplated by the maximum 50 percent rating.

Accordingly, an initial 50 percent rating is warranted.

REASONS FOR REMAND

Under the AMA, the Board must remand to the AOJ to correct pre-decisional duty to assist errors (including when the AOJ failed to make reasonable efforts to obtain VA treatment records or relevant federal or private treatment records, failed to obtain a VA examination, or provided an inadequate VA examination or opinion). 38 C.F.R. § 20.802(a).

Service Connection for an Acquired Psychiatric Disorder, to include PTSD, Anxiety, and Depression

The Veteran contends that he has a mental health condition that is related to an in-service TBI.

VA treatment records from January 2023 indicate a diagnosis of depression and symptoms of PTSD, with an evaluation for PTSD administered and such resulted in a score of 5 out of 5.
, the Board must remand to the AOJ to correct pre-decisional duty to assist errors (including when the AOJ failed to make reasonable efforts to obtain VA treatment records or relevant federal or private treatment records, failed to obtain a VA examination, or provided an inadequate VA examination or opinion). 38 C.F.R. § 20.802(a).

Service Connection for an Acquired Psychiatric Disorder, to include PTSD, Anxiety, and Depression

The Veteran contends that he has a mental health condition that is related to an in-service TBI.

VA treatment records from January 2023 indicate a diagnosis of depression and symptoms of PTSD, with an evaluation for PTSD administered and such resulted in a score of 5 out of 5. However, in a June 2024 VA examination report, the examiner found no diagnosis under the DSM-5 criteria. Nevertheless, an opinion was requested regarding the etiology of the Veteran's claimed acquired psychiatric disorder. In May 2025, a VA clinician opined that the claimed condition (PTSD) is at least as likely as not proximately due to or the result of the Veteran's service-connected condition, but provided, the rationale in support of the opinion pertains to the Veteran's migraines. Notably, the clinician concluded that the claimed condition of TBI causing residual migraine is at least as likely as not proximately due to or the result of the Veteran's service connected TBI.

As such, the examination and opinion of record are inadequate for adjudication purposes. Therefore, remand is necessary to obtain an adequate VA opinion to correct this pre-decisional duty to assist error.

Increased Rating for Residuals of TBI

The claim for an initial compensable rating for residuals of TBI is inextricable intertwined with the above claim for service connection for an acquired psychiatric disability. As such, adjudication of this matter is deferred. See Harris v. Derwinski, 1 Vet. App. 180 (1991).

TDIU

The issue of entitlement to a TDIU was reasonably raised by the record as part and parcel to the Veteran's claim for an increased rating for migraines prior to the decision on appeal. See October 2024 VA Form 20-0996 Request for Higher-Level Review (arguing that the Veteran's migraine symptoms impact his ability to maintain gainful employment); Rice v. Shinseki, 22 Vet. App. 447 (2009). However, the AOJ did not develop or adjudicate this issue in the May 2025 decision on appeal. The Board finds that this is a pre-decisional duty to assist error, and remand is required for the AOJ to develop and adjudicate the issue of entitlement to a TDIU in the first instance.

The matters are REMANDED for the following action:

1. Obtain an opinion from an appropriate clinician to determine the nature and etiology of the Veteran's claimed acquired psychiatric disorder, include posttraumatic stress disorder (PTSD), anxiety, and depression. The entire claims file and a copy of this remand must be made available to the clinician, and review should be noted. After complete review of the claims file, the clinician should address the following:

(a.) Identify any and all psychiatric disorders during the appeal period, to include PTSD, anxiety, and depression. If necessary, reconcile any discrepancies between the findings and the January 2023 VA treatment record noting a diagnosis of depression, symptoms of PTSD, and a PTSD assessment score of 5/5.

(b.) For each diagnosis, provide an opinion as to whether the Veteran's psychiatric disorder at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) had its onset during active service, within one year following active service, or is otherwise related to any in-service injury, event, or disease, to include the in-service traumatic brain injury (TBI).

(c.) For each diagnosis, provide an opinion as to whether any psychiatric disorder is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) (1) caused or (2) aggravated by his service-connected residuals of TBI.

The clinician must consider the Veteran's medical history and lay statements of record. The clinician should also consider the articles submitted by the Veteran. See October 2024 Correspondence.

The clinician is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion.

A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the clinician must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion.

2. Provide the Veteran and his representative notice pursuant to the Veterans Claims Assistance Act (VCAA) as
his service-connected residuals of TBI.

The clinician must consider the Veteran's medical history and lay statements of record. The clinician should also consider the articles submitted by the Veteran. See October 2024 Correspondence.

The clinician is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion.

2. Provide the Veteran and his representative notice pursuant to the Veterans Claims Assistance Act (VCAA) as to the issue of entitlement to a TDIU. Additionally, ask him to complete a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. Thereafter, develop and adjudicate the TDIU claim.

J. JACK

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Kernen, 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.

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