MIGRAINE

M. PRYCE · 2026 · Case ID: A26039156

MIXED

Summary

The Veteran served from February 1996 to January 1999. The Veteran appeals the denial of service connection for tension headaches and seeks a higher rating for service-connected right ring finger osteomyelitis and a scar on the right ring finger. The Board found that new and relevant evidence was submitted regarding the tension headaches claim, specifically a headache log documenting frequency and severity, and a VA examination noting migraines started in 1998 and worsened since. This evidence suggests a possible continuity of symptomatology or an etiological nexus to an in-service headache. Consequently, the tension headaches claim is remanded for readjudication. For the right ring finger osteomyelitis, the Veteran argued the VA examiner did not fully account for pain and limitations. However, the Board found the evidence weighed against a compensable rating, noting full range of motion and lack of objective pain findings, consistent with a noncompensable rating under DC 5230 or 5227. The Veteran's lay reports of pain and stiffness were acknowledged but did not meet the criteria for a higher rating. Similarly, for the right ring finger scar, the Veteran argued the VA examiner did not account for pain and functional loss. The Board found the scar did not meet the criteria for a compensable rating under DC 7802, as it was not painful, unstable, or of significant area, and did not cause functional limitations. The insomnia claim, diagnosed as depressive disorder with cannabis and alcohol use disorders, is also remanded. The Veteran argued for direct service connection based on an in-service incident in Saudi Arabia involving breathing difficulties, and alternatively, secondary connection to allergic rhinitis. While the claim was developed under the secondary theory, the Board found the direct service connection theory was not fully developed, as the RO had not obtained a direct service connection opinion despite the Veteran's assertions of sleep and breathing issues since Saudi Arabia service. The case is remanded for additional development on the direct service connection for insomnia.

Rationale

New and relevant evidence submitted; VA examination noted onset and worsening of migraines; Possible continuity of symptomatology or etiological nexus

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250330-533103

Full Decision Text

Citation Nr: A26039156
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 250330-533103
DATE: April 27, 2026

ORDER

New and relevant evidence having been found, the request to readjudicate the claim of entitlement to service connection for tension headaches is granted.

Entitlement to a compensable rating for service-connected right ring finger osteomyelitis is denied.

Entitlement to a compensable rating for service-connected scar of the right ring finger is denied.

REMANDED

Entitlement to service connection for tension headaches is remanded.

Entitlement to service connection for insomnia, diagnosed as depressive disorder with alcohol and cannabis use disorder, including as secondary to allergic rhinitis is remanded.

FINDINGS OF FACT

1. Additional evidence associated with the claims file since the September 2023 rating decision tends to prove or disprove a matter in issue with regards to the claim of entitlement to service connection for tension headaches.

2. The Veteran's service-connected right ring finger osteomyelitis was not manifest by any limitation of motion, including during flare-ups and after repeated use over a period of time; the condition was manifest by subjectively reported symptoms of pain, swelling, and stiffness.

3. The Veteran's scar of the right ring finger is not manifest by an area or areas of 144 square inches (929 sq. cm.) or greater, it is not painful, it is not unstable, and it does not result in any functional impairments.

CONCLUSIONS OF LAW

1. New and relevant evidence has been received and readjudication of the claim of entitlement to service connection for tension headaches is required. 38 U.S.C. §§ 101(35), 5108; 38 C.F.R. §§ 3.156(d), 3.2501.

2. The criteria for entitlement to a compensable rating for service-connected right ring finger osteomyelitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Code (DC) 5230.

3. The criteria for entitlement to a compensable rating for service-connected scar of the right ring finger phalanx have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DCs 7800-7802, 7804.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from February 1996 to January 1999.

The May 2024 rating decision on appeal (headaches), the December 2024 rating decision on appeal (insomnia, right ring finger osteomyelitis, right ring finger scar), the January 2025 rating decision on appeal (right ring finger osteomyelitis, right ring finger scar), and the March 2025 rating decision on appeal (insomnia) were issued under the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

As a matter of procedural clarity, the December 2024 rating decision addressed multiple claims, which included granting service connection for right finger osteomyelitis and a right finger scar, and denied service connection for insomnia. The Veteran submitted a December 2024 VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the December 2024 decision with regard to those three issues, specifically the rating assigned for the finger and finger scar, and service connection for insomnia. The agency of original jurisdiction (AOJ) then issued the January 2025 HLR decision on appeal, which considered the evidence of record at the time of the prior December 2024 decision. Therefore, with regard to the appeal of the January 2025 rating decision, the Board may only consider the evidence of record at the time of the December 2024 decision.

Although the Veteran initially requested HLR when submitting the December 2024 VA Form 20-0996, with regard to the service connection claim for insomnia, the Higher-Level Reviewer determined that there had been a duty to assist error with respect to the insomnia claim, requiring additional development. Thereafter, the AOJ issued a March 2025 rating decision adjudicating the merits of the insomnia claim.

The Veteran did not list the March 2025 rating decision in his March 2025 VA Form 10182 but instead listed the December 2024 rating decision which was later subject to HLR review which revealed a duty to assist error. In these circumstances, particularly where the time limit to appeal has otherwise expired, the Board will liberally construe the March 2025 VA Form 10182 to apply to the March 2025 rating decision addressing the merits of the insomnia claim. Comer v. Peake, 552 F.3d 1362, 1368 (Fed. Cir. 2009) ("A liberal and sympathetic reading of appeal submissions is necessary because a pro se veteran may lack a complete understanding of the subtle differences in various forms of VA disability benefits and of the sometimes arcane terminology used to describe those benefits."); Percy v. Shinseki, 23 Vet. App. 37, 47 (2009) ("the Board is required to address all claims reasonably raised in the Appellant's Substantive Appeal and in all of his documents and oral testimony submitted prior to the Board's decision"); see Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. June 18, 2015) ("A veteran's interest may be better served by prompt resolution of his claims rather than by further remands to cure procedural errors that, at the end of the day, may be irrelevant to final resolution and may indeed merely delay resolution."); see also Herndon v. Principi, 311 F.3d 1121, 1124 (Fed. Cir. 2002) (holding statement of the case need not specifically list an issue to be adequate, particularly where the Board must liberally construe the arguments set forth in a veteran's appeal); Bernard v. Brown, 4 Vet. App. 384, 390-91 (1993) (holding that the Board has authority "to decide all questions presented on the record before it that were necessary to its decision on the matter"); Shinseki v. Sanders, 556 U.S. 396, 407-11 (2009) (applying harmless error analysis in context of veterans benefit law).

Here, if the Board limited consideration to the record at the time of the December 2024 rating decision, remand would be required for to obtain an adequate opinion which was done in March 2025. Because the development has already been completed and the Veteran has expressed a clear intent to obtain a decision on the merits, the Board will liberally construe the March 2025 VA Form 10182 as an appeal of the March 2025 rating decision with regard to the insomnia claim.

In the March 2025 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 May 2024 agency of original jurisdiction (AOJ) decision on appeal with respect to the headache claim), at the time of the December 2024 rating decision with respect to the right ring finger claims) which rating decision was subsequently subject to higher-level review, and at the time of the March 2025 rating decision with respect to the insomnia claim. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal with respect to each issue 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 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.

Because the Board is remanding the claim of entitlement to service connection for tension headaches, any evidence the Board could not consider with regard to that claim will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Period on
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.

Period on Appeal

As service connection for the right ring finger scar and right ring finger osteomyelitis was awarded effective August 28, 2024, that is the beginning date of the period on appeal. However, while the Veteran's continuously pursued claim is before the Board on appellate review, there is a defined evidentiary record. Here, based on the Veteran's direct review docket choice and the evidentiary rules established by Congress for AMA appeals, the window to submit evidence closed December 11, 2024 (the date of the decision that was subject to higher-level review and is now on appeal). If the Veteran would like VA to consider any evidence that was added to the claims file 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.

1. The request to readjudicate the claim of entitlement to service connection for tension headaches

A claimant may continuously pursue a claim or issue by filing a supplemental claim following notice of a decision by the AOJ or the Board. 38 C.F.R. § 3.2500(c). If new and relevant evidence is presented or secured with respect to the supplemental claim, the AOJ will readjudicate the claim taking into consideration all of the evidence of record. 38 C.F.R. § 3.2501. New evidence is evidence not previously part of the actual record before agency adjudicators. 38 C.F.R. § 3.2501(a)(1). Relevant evidence is information that tends to prove or disprove a matter at issue in a claim, including evidence that raises a theory of entitlement that was not previously addressed. 38 C.F.R. § 3.2501(a)(2). If new and relevant evidence is not presented or secured, the AOJ will issue a decision finding that there was insufficient evidence to readjudicate the claim. Id.

In a September 2023 rating decision, the AOJ denied service connection for tension headaches based on the determination that there was insufficient evidence of an etiological nexus between conceded in-service events (e.g., a documented tension headache and participated in toxic exposure risk activity (TERA)).

In a January 2024 higher-level review (HLR) decision, the AOJ further explained that the claim for service connection for tension headaches remained denied "because the current condition is unrelated to military service." The AOJ discussed the negative opinions of the May 2023 VA examiner and the lack of evidence of a chronic condition since service.

The May 2024 rating decision on appeal found that new and relevant evidence had not been submitted since the September 2023 rating decision. The AOJ stated that treatment records form the Hampton VAMC and additional statements by the Veteran did not constitute relevant evidence "because it does not prove or disprove a matter at issue within your claim." Importantly, the Veteran submitted a headache log which documented the subjective severity and frequency of his headache condition. While this goes to the already established element of the existence of a current condition, the M21-1 notes that "new evidence that affirms findings previously deemed favorable to a claimant is still relevant." M21-1.X.ii.2.A.2.d. However, the Board is not bound by the M21-1 and rests its findings on the plain language of the regulations. See Overton v. Wilkie, 30 Vet. App. 257, 263-264 (2018). The Board need not address whether the new evidence further substantiating the existence of a current disability constitutes relevant evidence under 38 C.F.R. § 3.2501 and the particular facts of this case, because the record also includes a May 2024 VA examination (TBI) which contains the following statement regarding the onset of the Veteran's headaches: "This was in 1998 and is when his migraines started and have gotten progressively worse since." This is favorable evidence indicating the possibility of either
not bound by the M21-1 and rests its findings on the plain language of the regulations. See Overton v. Wilkie, 30 Vet. App. 257, 263-264 (2018). The Board need not address whether the new evidence further substantiating the existence of a current disability constitutes relevant evidence under 38 C.F.R. § 3.2501 and the particular facts of this case, because the record also includes a May 2024 VA examination (TBI) which contains the following statement regarding the onset of the Veteran's headaches: "This was in 1998 and is when his migraines started and have gotten progressively worse since." This is favorable evidence indicating the possibility of either a continuity of symptomatology since 1998 or an etiological nexus between the current headaches and the headache during service in 1998. In either case, the May 2024 VA examination constitutes new and relevant evidence going to the nexus element of the Veteran's claim.

The evidence received since the September 2023 rating decision denying the claim is new and relevant evidence and readjudication of the claim of entitlement to service connection for tension headaches is warranted.

2. Entitlement to a compensable rating for service-connected right ring finger osteomyelitis

The Veteran is seeking a compensable rating for his service-connected right ring finger osteomyelitis. He argues that his "entire hand and fingers get extremely stiff and causes [him] quite a bit of pain on a daily basis." He has further argued that the VA examiner "did not fully account for his pain and limitations for this condition."

The Veteran's right ring finger osteomyelitis is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5230, for limitation of motion of the ring or little finger. Under Diagnostic Code 5230, a noncompensable rating is warranted for any limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5230.

A disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of "the normal working movements of the body," such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40); see also DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995).

The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis, to include in situations where the disability at issue is not evaluated based on range of motion measurements. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011); Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

The December 2024 VA examination documented full range of motion of all right hand fingers on both active and passive range of motion. The examiner noted the Veteran's report of pain and stiffness. The examiner opined that the procured evidence did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with flare-ups or after repetitive use over a period of time and indicated no additional loss of range of motion in either circumstance. The examiner also noted no objective evidence of pain or tenderness. The examiner noted swelling and disturbance of locomotion, and less movement than normal affecting the right hand based on the Veteran's lay report. The Veteran had full strength and no muscle atrophy. There were no other pertinent physical findings, complications, conditions, signs or symptoms related to the right ring finger condition. The functional impairment of the right ring finger was not of such severity that no effective function remained that could not be equally well served by an amputation with prosthesis. The Veteran reported difficulty driving, holding a cell phone, typing, or using a power drill for a long time due to pain.

The Board finds that the evidence of record persuasively weighs against a compensable rating for the Veteran's service-connected right ring finger osteomyelitis. These findings are consistent with a noncompensable rating under DC 5230 (or 5227) as the physical findings and the VA examiner's opinion was that the Veteran did not have any limitation of motion, including during flare-ups or after repetitive use over a period of time. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to stiffness and pain. However, as noted above, the rating schedule only provides for a noncompensable rating for limitation of motion of the ring finger under DC 5230, which includes limitation of motion due to such factors as stiffness or pain. Moreover, even considering the Veteran's lay reports of symptoms and functional loss, the degree of additional limitation reflected by the lay statements that would not result in symptoms more nearly approximating any higher rating because the rating schedule provides no higher rating. See also 38 C.F.R. § 4.71a, DC 5227 (providing for a noncompensable rating for ankylosis, favorable or unfavorable, of the ring finger). Thus, there is no basis, on this record, for a compensable rating.

In conclusion, the Board finds that the evidence of record persuasively weighs against a compensable rating for right ring finger osteomyelitis. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. Entitlement to a compensable rating for service-connected scar of the right ring finger phalanx

The Veteran is seeking a higher rating but has limited his argument to suggesting the December 2024 VA examination did not properly account for pain and functional loss.

The Veteran's scar of the right ring finger is rated under Diagnostic Code (DC) 7802. The rating criteria provides for a maximum 10 percent rating for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage, when the area or areas of scar tissue are 144 square inches (929 square centimeters) or greater. For smaller scars, it is implied that a noncompensable rating should be assigned. 38 C.F.R. § 4.118, DC 7802.

The December 2024 VA examination of the right ring finger that was not painful and was not unstable. The scar was not due to a burn. The examiner measured the scar as 2.3cm by 0.1cm. The total approximate area was 0.23 centimeters squared. The scar did not cause any limitation of function to include limitation of motion. (As noted above, the Veteran had full motion of the right ring finger including during flare-ups and after repeated use over a period of time.) There were no other pertinent physical findings, complications, conditions, signs and/or symptoms. The scar had no impact on the Veteran's ability to work.

The Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under Diagnostic Code 7802 because the Veteran's scar of the right ring finger is not manifest by an area or areas of 144 square
3cm by 0.1cm. The total approximate area was 0.23 centimeters squared. The scar did not cause any limitation of function to include limitation of motion. (As noted above, the Veteran had full motion of the right ring finger including during flare-ups and after repeated use over a period of time.) There were no other pertinent physical findings, complications, conditions, signs and/or symptoms. The scar had no impact on the Veteran's ability to work.

The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's right ring finger scar is not of the head, face, or neck, is not deep and non-linear, and is not associated with underlying soft tissue damage. Moreover, the Veteran's scar of the right ring finger is not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, and 7804 are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under Diagnostic Code 7805.

The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran does not assert, and medical treatment records and the VA examination do not show, that the Veteran's scar of the right ring finger is manifest by an area or areas of 144 square inches (929 sq. cm.) or greater or that it is painful, unstable, or results in any functional limitations.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for the service-connected scar of the right ring finger. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Entitlement to service connection for tension headaches is remanded.

As noted above, the Board has determined that these claims must be readjudicated based on the submission of new and relevant evidence. However, in the decision on appeal, the AOJ did not consider the merits of the underlying claims. Generally, where the Board finds readjudication of a claim is warranted, but the AOJ did not, the case must be remanded for AOJ adjudication with consideration of the merits of the claim in the first instance unless there is a waiver from the appellant or no prejudice would result from the readjudication of the claim. See Hickson v. Shinseki, 23 Vet. App. 394, 399 (2010).

The AMA limits the circumstances in which the Board must remand appeals to the AOJ for further development. Nevertheless, even under the AMA, the Board still has the duty to remand to correct any error by the AOJ in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a). Thus, a remand for initial readjudication on the merits is necessary, as the Veteran has a procedural right to have review of his appeal by the AOJ.

The AOJ is reminded that it must fulfill the requisite duties attached to an adjudication of an issue on the merits, including the duty to assist in the development of the claim as contemplated by the discussion in Hickson.

2. Entitlement to service connection for insomnia, diagnosed as depressive disorder with cannabis use and alcohol use disorders, is remanded.

The Veteran contends that he has insomnia, which has been diagnosed as depressive disorder with cannabis and alcohol use disorder, which is either directly related to active service or, in the alternative, is secondary to his service-connected allergic rhinitis. Specifically, on a direct basis, the Veteran has argued that he has sleep-related issues which commenced during an incident in Saudia Arabia when he woke up in a tent with poor ventilation and was unable to breathe.

While the Veteran's claim has been developed under the secondary theory of service connection, the Veteran's
the development of the claim as contemplated by the discussion in Hickson.

2. Entitlement to service connection for insomnia, diagnosed as depressive disorder with cannabis use and alcohol use disorders, is remanded.

While the Veteran's claim has been developed under the secondary theory of service connection, the Veteran's claim has not been fully developed on a direct basis. Specifically, the RO has consistently noted that it has not obtained a medical opinion on direct service connection because there is no competent medical or scientific evidence of an association between the Veteran's conceded toxic exposure risk activity (TERA) and his diagnosed condition. However, the Veteran has asserted that he has experienced sleep and associated breathing related issues since his time serving in Saudi Arabia. The Veteran is competent, as a lay person, to report observable symptoms such as sleep difficulties and breathing issues. Given this assertion, the Board finds that the RO should have also obtained a direct service connection opinion. As such, this claim will be remanded so that additional development may be completed.

The matters are REMANDED for the following action:

1. After undertaking any additional development deemed warranted, take adjudicatory action on the merits of the Veteran's claim of entitlement to service connection for tension headaches.

2. Obtain an addendum medical opinion with regard to the Veteran's claimed insomnia, which has been diagnosed as a symptom of his depressive disorder. The complete claims file should be made available to the examiner selected to provide the opinion. The need for a new examination is left to the discretion of the examiner.

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The examiner is requested to review the claims file and state whether it is at least as likely as not that the Veteran's acquired psychiatric disorder had onset during active service or is otherwise related to any incident of active service (to include his conceded TERA). In providing the opinion, the examiner is reminded that the Veteran is competent to report observable symptoms in service and has stated that he first experienced insomnia-related symptoms while stationed in Saudi Arabia.

A complete rationale should accompany any opinion offered.

M. Pryce

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Hubers, Kerry

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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