MIGRAINE

Summary

The veteran, who served from July 2001 to July 2005, appeals the denial of an increased disability rating for migraine headaches for the period beginning December 28, 2020. Service connection for migraines was previously granted at 30 percent. The veteran sought a rating in excess of 30 percent, which would require symptoms productive of severe economic inadaptability. The Board reviewed the January 2021 VA examination, the veteran's testimony from an October 2022 hearing, and a migraine log submitted by the veteran. The VA examiner found the veteran experienced characteristic prostrating attacks of migraine headaches once a month, but did not find them to be very prostrating and prolonged attacks productive of severe economic inadaptability, noting only about one week of missed work in the prior 12 months. The veteran testified to having 2-3 migraines per month, requiring rest, and impacting his ability to work at least once per week, but he had sick leave and vacation time available and did not report unpaid leave. The Board found the veteran's testimony credible regarding the frequency and prostrating nature of his migraines, but concluded that these symptoms, even with medication and rest, were not productive of severe economic inadaptability. The Board noted that ringing in the ears during migraines was already compensated by a 10 percent rating for tinnitus. Ultimately, the Board found the evidence was not evenly balanced and denied the claim for an increased rating.

Rationale

VA treatment records did not show reports of or treatment for headaches during the applicable period.; January 2021 VA examiner found characteristic prostrating attacks once a month, but not very prostrating and prolonged attacks productive of severe economic inadaptability.; Veteran's testimony indicated 2-3 migraines per month requiring rest, impacting work once per week, but not resulting in unpaid leave or severe economic inadaptability.

Full Decision Text

Citation Nr: A26039233
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 210506-157938
DATE: April 28, 2026

ORDER

Since December 28, 2020, entitlement to a rating in excess of 30 percent for migraine headaches is denied.

FINDING OF FACT

Since December 28, 2020, the Veteran's migraines were not productive of severe economic inadaptability.

CONCLUSION OF LAW

Since December 28, 2020, the criteria for a disability rating in excess of 30 percent for migraines have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from July 2001 to July 2005.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2021 rating decision by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

In the May 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on October 21, 2022. Therefore, the Board may only consider the evidence of record at the time of the January 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran or 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 on appeal 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 or new evidence for Board consideration, 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. 

As an initial matter, service connection for migraines was granted in an October 2020 rating decision as 30 percent disabling effective August 13, 2020, his date of claim. The Veteran then filed a new claim on December 28, 2020 seeking a rating in excess of 30 percent for migraine headaches which was denied by way of a January 2021 rating decision. The Veteran appealed the October 2020 decision by submitting a January 2021 Notice of Disagreement but separately appealed the January 2021 rating decision by submitting the May 2021 Notice of Disagreement. Entitlement to an initial rating in excess of 30 percent for migraine headaches prior to December 28, 2020 was addressed in a separate Board decision under docket number 210128-136334 that was issued on April 8, 2026. The only issue currently before the Board is whether entitlement to a rating in excess of 30 percent is warranted from December 28, 2020. 

Neither the Veteran nor representative has raised any issues with the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board...to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument).

1. Since December 28, 2020, entitlement to a rating in excess of 30 percent for migraine headaches.

The Veteran seeks a rating in excess of 30 percent for his migraine headache symptoms. As discussed above, the period on appeal in this decision begins on December 28, 2020. As the Veteran's appeal for an initial rating in excess of 30 percent for migraines headaches prior to December 28, 2020 remains on appeal under docket number 210128
 arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument).

1. Since December 28, 2020, entitlement to a rating in excess of 30 percent for migraine headaches.

The Veteran seeks a rating in excess of 30 percent for his migraine headache symptoms. As discussed above, the period on appeal in this decision begins on December 28, 2020. As the Veteran's appeal for an initial rating in excess of 30 percent for migraines headaches prior to December 28, 2020 remains on appeal under docket number 210128-136334, the Board will focus on evidence relevant to the current period on review. Evidence prior to this date will be addressed and considered in the Board decision issued under docket number 210128-136334.

Migraine headaches are rated pursuant to 38?C.F.R. §?4.124a, Diagnostic Code (DC) 8100, for migraine. 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, with regard to severe economic inadaptability, nothing in DC 8100 requires that 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).

Severe may be defined in this context as "causing discomfort or hardship," "very painful or harmful," or "of a great degree." See https://www.merriam-webster.com/dictionary/severe (last visited 3/25/2026).

The Veteran's VA treatment records do not show any reports of or treatment for headaches during the applicable evidentiary window. 

In a January 2021 VA examination, the Veteran reported he had not sought medical care for migraines in the last 18 months. He reported two migraines per week and episodes where he has to lay down in a dark room. He uses Tylenol and motrin as treatment for his migraines. He reported pulsating and throbbing head pain on both sides of his head. His pain starts in the occipital region and spreads to the entire head. He endorsed sensitivity to light and ringing in the ears when he has a migraine. His head pain lasts for less than one day. The examiner found
).

The Veteran's VA treatment records do not show any reports of or treatment for headaches during the applicable evidentiary window. 

In a January 2021 VA examination, the Veteran reported he had not sought medical care for migraines in the last 18 months. He reported two migraines per week and episodes where he has to lay down in a dark room. He uses Tylenol and motrin as treatment for his migraines. He reported pulsating and throbbing head pain on both sides of his head. His pain starts in the occipital region and spreads to the entire head. He endorsed sensitivity to light and ringing in the ears when he has a migraine. His head pain lasts for less than one day. The examiner found the Veteran had characteristic prostrating attacks of migraine head pain once every month. However, the Veteran did not have any very prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability. The examiner checked the box to indicate the Veteran's migraine pain would impact his ability to work. Specifically, he lost "0-1 week" of work time in the last 12 months as his migraines limit his ability to work around bright lights. 

The Veteran submitted several documents after the issuance of the January 2021 decision notice. Most of these records were not resubmitted in the 90 days after the October 2022 hearing and cannot be considered in this decision. 

The Board hearing was held on October 21, 2022. While the recording included testimony from several different dockets, the Board will focus on the testimony provided regarding entitlement to a rating in excess of 30 percent for migraine headaches since December 28, 2020. The Veteran reported having 2 to 3 headaches per month. He had to sleep his headache off or else it would not go away. He reported missing days of work when headaches occur in the morning and leaving work if his headaches occur in the afternoon. The Veteran contends he would not be as productive at work when he has a headache. He asserts his work is impacted at least once per week due to his head pain. Regarding the January 2021 VA examination, the Veteran reported he actually told the examiner he had 2 to 3 headaches per month and he was unsure why they only indicated one per month. When asked if his place of employment knew about his headaches, the Veteran asserted he was not sure but that they did know about his psychiatric symptoms. He uses sick leave when he has a headache and the record reflects that he receives 40 hours of sick leave in addition to his vacation time. As his sick leave has run out, he has started using his vacation time when he needs to leave early. If he runs out of vacation time, he does not get paid for the time he was not at work. However, the Veteran has not indicated he has been without pay at any point due to head pain and missed workdays or that the use of all his sick leave was due to his migraine symptoms. In closing, the Veteran indicated when he gets a headache, his day is done. When asked about his occupational ability or ability to earn an income, the Veteran stated he worked from 6am to 2:30pm and with his head pain, he would not be able to get a second part time job. 

After the hearing, the Veteran submitted a copy of an October 2020 VA examination which is not probative to the period since December 28, 2020. Additional medical records were also submitted but were not relevant to the period on review. 

In December 2022, the Veteran submitted a migraine report for the period from August 24, 2020 to September 23, 2021. On December 28, 2020, the Veteran reported a migraine lasting 4 hours with 8 out of 10 pain. The last migraine was noted to be 21 days prior. The Veteran reported an additional 4-hour migraine on January 10, 2021 with 5 out of 10 head pain. The Veteran's log did not include any other reports of head pain between the December 28, 2020 and January 10, 2021 reports. 

In summary, the January 2021 VA examiner indicated the Veteran reported having 2 migraines per week. However, in the October 2022 hearing, the Veteran testified that he actually told the examiner he was having migraines 2 to 3 times per month that require him to sleep off the pain. He reported missing at most 1 week of work due to head pain in the 12 months prior to the January 2021 VA examination. The Veteran's head pain lasted for less than one day as evidence by the January 2021 examination and his migraine report. While a migraine means he must be done for the day, he still reported missing at most 1 week of work due
 10, 2021 reports. 

In summary, the January 2021 VA examiner indicated the Veteran reported having 2 migraines per week. However, in the October 2022 hearing, the Veteran testified that he actually told the examiner he was having migraines 2 to 3 times per month that require him to sleep off the pain. He reported missing at most 1 week of work due to head pain in the 12 months prior to the January 2021 VA examination. The Veteran's head pain lasted for less than one day as evidence by the January 2021 examination and his migraine report. While a migraine means he must be done for the day, he still reported missing at most 1 week of work due to his migraine symptoms. During the hearing the Veteran indicated he had 40 hours of sick leave for the year which was used and he is now using vacation leave. When asked how his head pains impact his earning capacity, the Veteran stated he already worked from 6am to 2:30pm but would be prevented from getting a second part time job due to his headaches. 

The Veteran is competent to report readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds no reason to doubt his credibility in this matter. As such, it is likely the Veteran is having at least 2 to 3 migraines per month that require him to sleep (i.e., prostrating). The migraine report showed during the period on review, his head pain lasted about 4 hours at a time. 

When considering all relevant evidence of record, the Board finds that while the Veteran's migraines occurred very frequently, were completely prostrating at times, and had the potential to be prolonged, they were not productive of severe economic inadaptability. The Veteran reported his work is impacted by his migraines once per week but he is not consistently missing work or paychecks. He reported missing at most 1 week of work in the 12 months prior to the January 18, 2021 VA examination. The Veteran reported running out of sick leave but did not attribute this solely to his migraine disability and he still had additional paid leave he was able to use. When asked how his head pain would impact his ability to earn an income, he asserted only an inability to obtain a second part time job to work after his day at his full-time job was complete. In summary, his migraine pain results in his absence from work for a few days per year but has not at any time resulted in unpaid leave, economic discomfort, hardship, or harm. While he reported his head pain impacts his work at least once per week, this disruption is already contemplated by his 30 percent rating. 

The Board acknowledges that in Jones v. Shinseki, 26 Vet. App. 56, 63 (2012), the Court of Appeals for Veterans Claims found that "the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria." In rating headaches or migraines under DC 8100, the Board may not consider the ameliorative effects of medication. Id. The Veteran reported Tylenol and motrin as needed for his head pain. However, he reported pain despite his medication use designed to prevent such a symptom. In contrast, the Veteran testified during the October 2022 Board hearing that if he does not sleep, his headache will not go away. The Board acknowledges the Veteran indicated the use of medication and that he used other non-medication based alleviating factors to reduce his pain, such as sleeping. However, the Veteran did not assert medication alone impacts his pain levels and has instead consistently reported significant pain throughout the period on appeal. The persuasive weight of the record does not show the Veteran's medication use significantly reduces his symptoms. Thus, there are no beneficial medication effects to discount. See Ingram v. Collins, 38 Vet. App. 130 (2025). 

As the record fails to show that the Veteran's symptoms could be worse without the use of medication and as these symptoms were not considered to be productive of severe economic inadaptability, there is no indication his symptoms have the potential to be productive of severe economic inadaptability. The Veteran's migraine symptoms and resulting economic impact do not arise to the level of potential or actual severe economic inadaptability. Rather, his migraine symptoms, including his report of once-a-week work interruption, are currently contemplated by his 30 percent disability rating under DC 8100.

In making the determination, the Board observes that the Veteran experienced ringing of his ears during migraine headaches. Throughout the pendency of this appeal, service connection has been in effect for the Veteran's tinnitus, for which he receives the maximum 10 percent rating. Accordingly
 the use of medication and as these symptoms were not considered to be productive of severe economic inadaptability, there is no indication his symptoms have the potential to be productive of severe economic inadaptability. The Veteran's migraine symptoms and resulting economic impact do not arise to the level of potential or actual severe economic inadaptability. Rather, his migraine symptoms, including his report of once-a-week work interruption, are currently contemplated by his 30 percent disability rating under DC 8100.

In making the determination, the Board observes that the Veteran experienced ringing of his ears during migraine headaches. Throughout the pendency of this appeal, service connection has been in effect for the Veteran's tinnitus, for which he receives the maximum 10 percent rating. Accordingly, the Veteran is already receiving disability compensation for this manifestation/impairment and a separate rating is not warranted. See 38 C.F.R. § 4.14. There remain no symptoms or consequences of the Veteran's migraine disability not currently considered by his 30 percent rating under DC 8100. 

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether entitlement to a rating in excess of 30 percent for migraines headaches is warranted. The benefit of the doubt doctrine does not apply. 38?U.S.C. §?5107(b), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is denied. 

 

Laura E. Collins

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Conti, S.

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.