MIGRAINE

Summary

The Veteran served on active duty from April 1979 to April 1983. This case comes before the Board of Veterans' Appeals (Board) on appeal from January 2026 rating decisions concerning claims for service connection for migraines and obstructive sleep apnea (OSA). The Veteran sought service connection for both conditions on a secondary basis, contending they were caused by his service-connected tinnitus. The Board reviewed the evidence of record at the time of the AOJ decisions, noting that any evidence submitted after those decisions could not be considered. The Board found that the Veteran had existing favorable findings for tinnitus, migraines, and OSA, establishing the first two elements for secondary service connection. The primary remaining issue was the nexus between the claimed conditions and the service-connected tinnitus. The Veteran submitted a January 2026 private medical opinion that linked migraines and OSA to tinnitus, explaining pathophysiological pathways and citing neurological networks. The Board found this opinion probative due to its adequate rationale and the examiner's credibility. In contrast, January 2026 VA examinations opined negatively on the nexus, stating the conditions were not medically related and citing literature suggesting OSA might precede tinnitus. However, the VA examiners failed to address the private nexus opinions. The Board found the private opinions more persuasive due to their detailed rationale and the VA examiners' failure to address contrary evidence. Consequently, the Board found a nexus established for both migraines and OSA secondary to tinnitus, granting service connection for both conditions.

Rationale

Favorable finding of current disability (migraines); Favorable finding of service-connected tinnitus; Nexus established by private medical opinion linking migraines to tinnitus

Full Decision Text

Citation Nr: A26037077
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 260204-638464
DATE: April 21, 2026

ORDER

Entitlement to service connection for migraines is granted on a secondary basis, effective August 9, 2023.

Entitlement to service connection for obstructive sleep apnea (OSA) is granted on a secondary basis, effective October 28, 2025.

FINDINGS OF FACT

1. The Veteran's migraines were caused by his service-connected tinnitus. 

2. The Veteran's OSA was caused by his service-connected tinnitus. 

CONCLUSIONS OF LAW

1. The criteria for service connection for migraines are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for OSA are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1979 to April 1983.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2026 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the February 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the January 2026 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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. 

Under the Appeals Modernization Act (AMA), a claim can be continuously pursued by filing an appropriate administrative review option to an AMA decision, generally within one year from when the decision was issued. If a claim is continuously pursued, it will be considered filed as of the date of the first claim in the continuously pursued chain, not the date the most recent request for review was received. See 38 C.F.R. § 3.2500(c)(h). 

On August 9, 2023, the Veteran filed a VA Form 21-0966, Intent to File a Claim. The Veteran then sought service connection for migraines through filing an April 2024 VA Form 21-526EZ, Fully Developed Claim. The RO denied this claim in an August 2024 rating decision. The Veteran sought readjudication of his claim through filing a February 2025 VA Form 21-0995, Supplemental Claim Application. The RO once again denied this claim in a May 2025 rating decision. The Veteran then initiated the present claim through filing a January 2026 VA Form 21-0995, Supplemental Claim Application. Therefore, for the purposes of assigning an effective date of any benefits awarded for migraines, the Board will consider August 9, 2023, as the date on which the claim was filed. 

On October 28, 2025, the Veteran filed a VA Form 21-0966, Intent to File a Claim. The Veteran then initiated the present claim through filing a January 2026 VA Form 21-526EZ, Fully Developed Claim. Therefore, for the purposes of assigning an effective date of any benefits awarded for OSA, the Board will consider October 28, 2025, as the date on which the claim was filed.

Service Connection

Service connection will be granted for a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty, in the active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 

Service connection requires evidence of (1) a
 the present claim through filing a January 2026 VA Form 21-526EZ, Fully Developed Claim. Therefore, for the purposes of assigning an effective date of any benefits awarded for OSA, the Board will consider October 28, 2025, as the date on which the claim was filed.

Service Connection

Service connection will be granted for a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty, in the active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 

Service connection requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). To establish secondary service connection there must be evidence: (1) of a current disability (for which secondary service connection is sought); (2) of an already service-connected disability; and (3) that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. § 3.310(a); see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection). For the purposes of aggravation, the central question was whether any worsening of the nonservice-connected disability is actually due to the service-connected disability, or whether the worsening is due to the natural progression of the disability. 38 C.F.R. § 3.310(b). 

1. Entitlement to service connection for migraines

2. Entitlement to service connection for obstructive sleep apnea

The Veteran seeks service connection for migraines and OSA, contending that they are caused by his service-connected tinnitus. 

After review of the evidence, the Board finds that service connection is warranted. 

The January 2026 rating decisions made a number of favorable findings, including that the Veteran had diagnoses of migraines and OSA and that he was service-connected for tinnitus. These favorable findings are binding on the Board. 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c). Therefore, the first two elements of service connection on a secondary basis are established. Given this, the only issue that remains is whether there is a nexus between the Veteran's disabilities and his service-connected tinnitus. 

The Veteran submitted a January 2026 private medical opinion in which the examiner opined that the Veteran's disabilities were caused by his service-connected tinnitus. The examiner noted his review of the claims file, including VA medical records, service treatment records, and the Veteran's reported symptoms. The examiner noted that the Veteran was exposed to in-service hazardous noise, which resulted in persistent ringing in his ears. As to the migraines, the examiner noted that this persistent ringing created repeated flare events that overwhelmed the Veteran's ability to focus or rest and ultimately escalated to migraine development. Additionally, the examiner noted that there existed a pathophysiological link between tinnitus and migraines as the two share neurological networks that regulate sensory processing, threat detection, and pain modulation. As tinnitus intensifies, the examiner explained, the nervous system becomes more reactive to normal light and sound which, in turn, renders one more susceptible to migraines. Further, sleep deprivation from tinnitus can promote chronic migraines. In the Veteran's case, the examiner opined, his service-connected tinnitus and additional symptoms caused the migraines in these ways. 

As to OSA, the examiner stated that the Veteran's sleep became progressively less restorative after his discharge due to his service-connected tinnitus. The examiner explained that tinnitus can repeatedly disrupt sleep leading to increased physiologic stress responses which altered ventilatory control during sleep. In this way, the examiner opined, tinnitus
 processing, threat detection, and pain modulation. As tinnitus intensifies, the examiner explained, the nervous system becomes more reactive to normal light and sound which, in turn, renders one more susceptible to migraines. Further, sleep deprivation from tinnitus can promote chronic migraines. In the Veteran's case, the examiner opined, his service-connected tinnitus and additional symptoms caused the migraines in these ways. 

As to OSA, the examiner stated that the Veteran's sleep became progressively less restorative after his discharge due to his service-connected tinnitus. The examiner explained that tinnitus can repeatedly disrupt sleep leading to increased physiologic stress responses which altered ventilatory control during sleep. In this way, the examiner opined, tinnitus causes the longterm sleep disruption that can contribute to the development of OSA by making sleep more fragmented and less resilient to airway collapse mechanisms characterized by OSA. In the Veteran's case, the examiner opined that his service-connected tinnitus and additional sleep-related symptoms caused the Veteran's OSA in these ways. 

The Board has no reason to question the examiner's competency and credibility, as they summarized the evidence upon which they relied and offered an adequate rationale for the opinions. Therefore, the Board affords the opinions significant probative weight on the issue of nexus.  

Upon VA examinations in January 2026, the examiners opined that the Veteran's migraines and OSA were not secondary to his service-connected tinnitus. As rationale, the examiners stated that the disabilities were not medically related and that medical literature failed to demonstrate a causal relationship. The OSA examiner cited research which tended to show that OSA preceded and contributed to tinnitus development rather than the other way around. Neither examiner addressed the private nexus opinions. 

The Board has no reason to question the examiners' competency and credibility, who summarized the evidence upon which they relied and offered an adequate rationale for the opinion. However, the VA is required to consider evidence that is favorable to the Veteran and the examiners' failures to address the private opinions render the VA opinions less probative than the private opinion.  

The Board finds that the evidence establishes a nexus between the Veteran's migraines, OSA, and his service-connected tinnitus. In so finding, the Board relies on the January 2026 private medical opinions in which the examiner clearly articulated the pathophysiological links between the disabilities for which the Veteran seeks service connection and his service-connected tinnitus. 

However, the evidence does not establish that the Veteran's service directly caused his migraines and OSA, nor does the Veteran allege such a cause. 

Therefore, service connection on a secondary basis is warranted for both migraines and OSA, and the claims are granted.  

 

 

Leetra J. Harris

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.S.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.