Back to BVA DecisionsGRANTEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 250430-540667
MIGRAINE
B. D. WATSON · 2026 · Case ID: A26036829
Summary
The Veteran, who served from June 1989 to March 1995, appeals the denial of service connection for migraine headaches and a mood disorder, both claimed as secondary to service-connected tinnitus. The Board reviewed the evidence, including VA examinations and the Veteran's submitted claims. For migraine headaches, the Board considered conflicting opinions: a VA Nurse Practitioner found a positive nexus, stating migraines were at least as likely as not proximately due to tinnitus, citing worsening symptoms with tinnitus and medication use. Conversely, a VA Physician Assistant found less than a likelihood of nexus, citing a lack of peer-reviewed literature directly linking tinnitus to migraines. The Board found the Nurse Practitioner's opinion more persuasive due to its thoroughness and consideration of the Veteran's contentions, granting service connection for migraines secondary to tinnitus. For the mood disorder, the Board reviewed two VA examinations. Both found the mood disorder was at least as likely as not proximately due to or the result of service-connected tinnitus. The first opinion cited the Veteran's reported sleep impairment from tinnitus and increased irritability. The second opinion cited research on the comorbidity of tinnitus and depression, and the Veteran's reported distress and functional impairments from tinnitus. With no contrary medical opinions, the Board granted service connection for the mood disorder secondary to tinnitus, resolving all reasonable doubt in the Veteran's favor.
Rationale
Favorable private medical opinion; Migraines proximately due to tinnitus; Resolved doubt in Veteran's favor
Full Decision Text
Citation Nr: A26036829 Decision Date: 04/21/26 Archive Date: 04/21/26 DOCKET NO. 250430-540667 DATE: April 21, 2026 ORDER Entitlement to service connection for migraine headaches as secondary to service-connected tinnitus is granted. Entitlement to service connection for mood disorder due to known physiological condition with depressive features as secondary to service-connected tinnitus is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in favor of the Veteran, his migraine headaches are proximately due to or the result of his service-connected tinnitus. 2. Resolving reasonable doubt in favor of the Veteran, his mood disorder due to known physiological condition with depressive features is due to or the result of his service-connected tinnitus. CONCLUSIONS OF LAW 1. The criteria for service connection for migraine headaches as secondary to service-connected tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for mood disorder due to known physiological condition with depressive features as secondary to service-connected tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1989 to March 1995. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in February 2025 by a Department of Veterans Affairs (VA) regional office, the agency of original jurisdiction (AOJ). In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Notably, the February 2025 rating decision was a higher-level review of two rating decisions issued in September 2024. Therefore, the Board may only consider the evidence of record at the time of the September 2024 rating decisions, respectively, as well as the evidence submitted by the Veteran and his representative with, and within 90 days from receipt of his April 2025 VA 10182 Notice of Disagreement (NOD) form. See 38 C.F.R. § 20.303. 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. Service connection may also be awarded on a secondary basis if a claimant suffers a disability that is "proximately due to or the result of a service-connected disease or injury." See 38 C.F.R. § 3.310(a). Service connection on a secondary basis may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). Thus, in order to establish entitlement to service connection on a secondary basis, there must be evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id. Service connection on 310(a). Service connection on a secondary basis may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). Thus, in order to establish entitlement to service connection on a secondary basis, there must be evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id. Service connection on a secondary basis may not be granted without medical evidence of a current disability and evidence of a nexus between the current disability and a service-connected disability. See Wallin v. West, 11 Vet. App. 509, 51214 (1998). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. See also Lynch v. McDonough, 21 F.4th 776 (2021). 1. Service connection for migraine headaches The Veteran asserts that his migraine headaches are secondary to his service-connected tinnitus. See e.g., VA Form 21-526EZ, Fully Developed Claim, associated 5/17/2024. At the outset, the Board notes that the Veteran did not contend, nor does the evidence reflect a migraine headaches disorder onset in or is otherwise related to his active duty service. Accordingly, the Board will not address direct service connection and will proceed to analysis of service connection on a secondary basis. As an initial matter, the Board notes that the AOJ favorably found that the Veteran has a current diagnosis of migraine headaches, and is already service-connected for tinnitus. See Rating Decisions, associated 9/5/2024, 2/6/2025. The Board is bound by such favorable findings by the AOJ. See 38 C.F.R. § 3.104(c). Thus, the remaining question for the Board is whether his migraine headaches were either (a) caused by or (b) aggravated by his service-connected tinnitus. On that point, the Board notes that there are competing opinions of record. In support of his claim, the Veteran submitted a VA Headaches Disability Benefits Questionnaire (DBQ) (dated 4/15/2024) completed by Nurse Practitioner L.H. under the supervision of R.C., MD. NP L.H. noted in-person examination of the Veteran and review of the Veteran's service treatment records and VA treatment records/notification letters. NP L.H. noted that the Veteran reported migraine headaches are secondary to his tinnitus, with worsened symptoms over the years that cause functional impairments due to his sensitivity to light and sound during his episodes of migraine headaches. NP L.H. noted the Veteran takes continuous medication (Verapamil) for his migraine headaches. The Veteran reported that his symptoms include: constant head pain, pain on both sides of head, pain worsens with physical activity, nausea, sensitivity to light/sound, restlessness, and excessive tearing in one eye. NP L.H. noted the Veteran's headaches produce characteristic prostrating attacks greater than once per month. No other pertinent physical findings, complications, or signs/symptoms related to the condition were indicated, and no diagnostic testing was performed. NP L.H. diagnosed the Veteran with "Migraine including migraine variants." See DBQ-Veteran Provided, associated 5/17/2024. Following exam and review of records, NP L.H. opined that the claimed migraine headaches condition was at least as likely as not proximately due to or the result of the Veteran's service-connected tinnitus. As to rationale, NP L.H. reasoned it is a well-established medical opinion that migraine headaches are triggered by an event and this Veteran gives a clear history of tinnitus prior to the onset of his headaches, and as his tinnitus worsens so do the headaches. In a May 2024 VA medical opinion DBQ, based on records review, the examiner, Physician Assistant K.K. opined that the Veteran's claimed condition was less likely than not proximately due to or the result of his service-connected tinnitus. As to rationale, PA K.K., reasoned that "there is insufficient evidence and a lack of peer-reviewed medical literature that establishes a direct causal relationship between tinnitus and development of Migraine Headaches." . As to rationale, NP L.H. reasoned it is a well-established medical opinion that migraine headaches are triggered by an event and this Veteran gives a clear history of tinnitus prior to the onset of his headaches, and as his tinnitus worsens so do the headaches. In a May 2024 VA medical opinion DBQ, based on records review, the examiner, Physician Assistant K.K. opined that the Veteran's claimed condition was less likely than not proximately due to or the result of his service-connected tinnitus. As to rationale, PA K.K., reasoned that "there is insufficient evidence and a lack of peer-reviewed medical literature that establishes a direct causal relationship between tinnitus and development of Migraine Headaches." It is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Moreover, when reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). In assessing medical opinions, the failure of the physician to provide a basis for his opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). A medical opinion may not be discounted solely because the examiner did not review the claims file. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the Board finds the April 2024 private medical opinion well-reasoned, as it was well-supported by in-person examination, review of the records, and full consideration of the Veteran's contentions. Thus, the Board affords it significant probative value. In contrast, the May 2024 VA medical opinion, being based on a records review only, without fully addressing the Veteran's contentions, reconciling the conflicting medical opinions, or opining on the aggravation prong of secondary service connection, is far less persuasive. Accordingly, and resolving all reasonable doubt in favor of the Veteran, the Board concludes that the evidence of record supports the Veteran's migraines headaches disorder is proximately due to or the result of his service-connected tinnitus. Service connection for migraine headaches as secondary to service-connected tinnitus is therefore GRANTED. 38 C.F.R. §§ 3.102, 3.310. 2. Service connection for mood disorder due to known physiological condition with depressive features The Veteran asserts that symptoms of his service-connected tinnitus result in his mood disorder. See e.g., VA Form 21-526EZ, associated 5/17/2024. At the outset, the Board notes that the Veteran did not contend, nor does the evidence reflect that his current mood disorder onset in or is otherwise related to his active duty service. Accordingly, the Board will not address direct service connection and will proceed to analysis of service connection on a secondary basis. As an initial matter, the Board notes that the AOJ favorably found that the Veteran has a current diagnosis of "Mood disorder due to known physiological condition with depressive features," and is already service-connected for tinnitus. See Rating Decisions, associated 9/26/2024, 2/6/2025. As noted, the Board is bound by such favorable findings by the AOJ. See 38 C.F.R. § 3.104(c). Thus, the remaining question for the Board is whether his "Mood disorder due to known physiological condition with his active duty service. Accordingly, the Board will not address direct service connection and will proceed to analysis of service connection on a secondary basis. As an initial matter, the Board notes that the AOJ favorably found that the Veteran has a current diagnosis of "Mood disorder due to known physiological condition with depressive features," and is already service-connected for tinnitus. See Rating Decisions, associated 9/26/2024, 2/6/2025. As noted, the Board is bound by such favorable findings by the AOJ. See 38 C.F.R. § 3.104(c). Thus, the remaining question for the Board is whether his "Mood disorder due to known physiological condition with depressive features," is either (a) caused by or (b) aggravated by his service-connected tinnitus. In VA examination for hearing and tinnitus in February 2020, the Veteran reported recurrent tinnitus since service. As to functional impact of his tinnitus, he reported "I find the tinnitus to affect my ability to fall and stay asleep." See C&P Exam, associated 2/7/2020. In support of his claim, the Veteran submitted a VA Mental Disorders DBQ (dated 3/13/2024) completed by Nurse Practitioner S.C. under the supervision of Dr. L.P., MD (Psychiatry). NP S.C. noted in-person examination of the Veteran and review of his service treatment records and VA treatment records/notification letters. NP S.C. noted the Veteran's reported histories as they related to: social/marital/family; occupational/educational; mental health/medications; legal/behavioral; and substance abuse. In particular, the Veteran reported that his chronic lack of sleep induced his anxiety which in turn strained his marital relationship, increased his irritability and mood swings, decreased his motivation to exercise, impacted his ability to get along with work colleagues, and impaired his judgment. The Veteran reported he currently is undergoing counseling and taking medications (i.e., Paxil) for his condition. Upon exam and review, NP S.C. diagnosed the Veteran with "Mood disorder due to known physiological condition with depressive features." The noted symptoms associated with his condition include (among others): depressed mood; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; mild memory loss; impairment of long and short term memory; flattened affect; impaired judgment; disturbances of motivation and mood. NP S.C. determined the Veteran's condition causes occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. NP S.C. observed the Veteran during assessment to be alert, oriented, and cooperative, and NP S.C. noted that the Veteran provided a concise and detailed account of both historical and current psychiatric symptoms and concurrent behaviors. NP S.C. also noted that the Veteran is capable of managing his own financial affairs. See DBQ-Veteran Provided, associated 5/17/2024. Based on examination/interview and review of records, NP L.H. opined that it was at least as likely as not that the Veteran developed the mood disorder as due to his service-connected tinnitus, and that his symptoms have contributed significantly to impairments both occupationally and socially. In a May 2024 VA medical opinion DBQ, based on records review, the examiner, T.S., PsyD (Psychology) opined that the Veteran's claimed condition is at least as likely as not proximately due to or the result of his service-connected tinnitus. As to rationale, Dr. T.S. reasoned that the Veteran met criteria for mood disorder due to known physiological condition with depressive disorder with depressive features on the exam, the Veteran's service-connected tinnitus is causing significant distress or impairment in social, occupational, or other important areas of functioning, and research indicates: epidemiological studies indicate increased rates of co-morbid depression among patients with tinnitus, tinnitus severity correlates highly with the amount of depressive symptoms and finally tinnitus and depression overlap in their neurobiological alterations [sources cited]. On an addendum/clarification, Dr. T.S. answered the query "Veteran's mood disorder is due to tinnitus." See C&P Exam, associated 6/1/2024, 9/14/2024. Based on the foregoing, the probative opinions favor service connection. There are no medical opinions to the contrary. Accordingly, and resolving all reasonable doubt in favor of the Veteran, the Board concludes that the evidence of record supports the Veteran's "Mood disorder due to known physiological condition with depressive features" is proximately due to or the result of his service-connected tinnitus. Service connection for mood disorder due to known physiological condition in their neurobiological alterations [sources cited]. On an addendum/clarification, Dr. T.S. answered the query "Veteran's mood disorder is due to tinnitus." See C&P Exam, associated 6/1/2024, 9/14/2024. Based on the foregoing, the probative opinions favor service connection. There are no medical opinions to the contrary. Accordingly, and resolving all reasonable doubt in favor of the Veteran, the Board concludes that the evidence of record supports the Veteran's "Mood disorder due to known physiological condition with depressive features" is proximately due to or the result of his service-connected tinnitus. Service connection for mood disorder due to known physiological condition with depressive features as secondary to service-connected tinnitus is therefore GRANTED. 38 C.F.R. §§ 3.102, 3.310. B. D. WATSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Picard 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.