MIGRAINE

Summary

The Veteran, an Army Veteran who served from May 2008 to November 2008, May 2012 to June 2013, and May 2022 to April 2023, appeals a rating decision concerning headaches. The Veteran sought an increased rating for his service-connected headaches, specifically arguing for a 50 percent rating to be effective from April 23, 2023, rather than the April 2025 effective date assigned by the agency of original jurisdiction. The Board reviewed the evidence of record at the time of the prior rating decision, as the Veteran elected a Direct Review docket. The primary evidence included service treatment records noting frequent headaches, a lay statement describing them as very frequent, prostrating, and prolonged attacks causing economic inadaptability, and a VA examination. The VA examiner diagnosed headaches, noted they began approximately nine months prior to the exam, occurred daily, lasted for hours, and negatively affected concentration, but opined the Veteran did not experience prostrating migraine attacks. However, the Board found the Veteran's headaches met the criteria for a 50 percent rating throughout the entire period on appeal, citing the frequency (daily, with more intense attacks three times per week), accompanying symptoms like aura, imbalance, photosensitivity, and phonophobia, and the Veteran's own description of economic inadaptability. The Board granted the 50 percent rating for headaches, the maximum schedular rating under Diagnostic Code 8100, effective April 23, 2023.

Rationale

Service treatment records noted frequent headaches.; Veteran's lay statement described headaches as very frequent, prostrating, prolonged attacks causing economic inadaptability.; VA examiner noted headaches negatively affected concentration, though opined Veteran did not have prostrating attacks.; Board found headaches met criteria for 50% rating based on frequency, accompanying symptoms, and economic inadaptability.

Full Decision Text

Citation Nr: A26040194
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 250718-566513
DATE: April 29, 2026

ORDER

Entitlement to a 50 percent disability rating for headaches for the entire period on appeal is granted, subject to regulations governing payment of monetary benefits.

FINDING OF FACT

For the period on appeal, the Veteran's headaches manifested in very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.  

CONCLUSION OF LAW

The criteria for a 50 percent rating for headaches, for the entire period on appeal, have 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 had active military service in the United States Army from May 2008 to November 2008, from to May 2012 to June 2013, and from May 2022 to April 2023.

In April 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an April 2025 rating decision.  In July 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior April 2025 rating decision.  

In the July 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 April 2025 rating decision on appeal, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal, which was subsequently subject to higher-level review, 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Finally, a claim for a total rating based on individual unemployability (TDIU) due to service-connected disability, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Veteran has not argued, and the record does not otherwise reflect, that the disability adjudicated in this decision renders him unemployable. While he has contended interference with employment, this is contemplated in the rating assigned by this decision, which specifically addresses "severe economic inadaptability" but does not require and is different than unemployability. 38 C.F.R. § 4.1. Accordingly, no further consideration of entitlement to TDIU under Rice is required.

Increased Rating

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a "staged" rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. This applies to established ratings as well as initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

An earlier effective date for a
1.

Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a "staged" rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. This applies to established ratings as well as initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

An earlier effective date for a 50 percent disability rating for headaches.

The Veteran's service-connected headaches are rated noncompensably disabling (zero percent) effective April 23, 2023, the date service connection was granted, and also the date after the Veteran's separation from his last period of active duty service. A 50 percent rating was awarded effective December 16, 2024, under 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Veteran's representative asserts that the 50 percent rating should be effective April 23, 2023. See July 2025 VA Form 10182 Notice of Disagreement. 

Under Diagnostic Code 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. The 50 percent maximum rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

The rating criteria of Diagnostic Code 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. See Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Id. at 252.

The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under Diagnostic Code 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 headache 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 headache 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 Diagnostic Code 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).

Service treatment records (STRs) note the Veteran experienced frequent headaches. See November 2022 service treatment records. 

The Veteran submitted a statement describing his headaches as "very frequent prostrating and prolonged attacks that cause economic inadaptability" because he could not work or function when he had the attacks. See July 2023 Statement.

The Veteran was afforded a VA examination in August 2023. The VA examiner diagnosed headaches and noted that the Veteran reported his headaches beginning approximately 9 months ago. The Veteran also reported his headaches occurred daily and lasted for hours. The Veteran reported he sometimes took Ibuprofen and was able to work through his headaches. The VA examiner noted the Veteran's symptoms to be pulsating or throbbing head pain and pain on both sides
s) note the Veteran experienced frequent headaches. See November 2022 service treatment records. 

The Veteran submitted a statement describing his headaches as "very frequent prostrating and prolonged attacks that cause economic inadaptability" because he could not work or function when he had the attacks. See July 2023 Statement.

The Veteran was afforded a VA examination in August 2023. The VA examiner diagnosed headaches and noted that the Veteran reported his headaches beginning approximately 9 months ago. The Veteran also reported his headaches occurred daily and lasted for hours. The Veteran reported he sometimes took Ibuprofen and was able to work through his headaches. The VA examiner noted the Veteran's symptoms to be pulsating or throbbing head pain and pain on both sides of his head. The VA examiner noted the Veteran did not experience prostrating migraine attacks. The VA examiner noted that the Veteran's migraines negatively affected his ability to concentrate.

In December 2023, the Veteran reported that his headaches began while he was deployed to Kuwait. See December 2023 VA outpatient treatment record. He also reported that he experienced headaches daily, with more intense headaches around three times per week. The Veteran stated that his headaches last 30 minutes to several hours and that he takes Ibuprofen. The Veteran reported experiencing an aura of white spots or flashes, imbalance, photosensitivity, and phonophobia.  

Based on a review of the record, the Board concludes that an initial 50 percent rating, the maximum schedular rating, is warranted for the Veteran's headaches for the entire period on appeal.

While the August 2023 VA examiner opined that the Veteran did not have prostrating and prolonged attacks of headache pain, it is clear from the record that the Veteran's headaches were frequent, including daily headaches with more intense headaches around three times per week, and were accompanied by symptoms including experiencing aura of white spots or flashes, imbalance, and photosensitivity and phonophobia, all of which caused a functional loss limiting his ability to function in an occupational setting. Additionally, the Veteran stated his headaches were "very frequent prostrating and prolonged attacks that cause economic inadaptability" because he could not work or function when he had the attacks. See July 2023 Statement. Further, the August 2023 VA examiner noted the Veteran's headaches negatively affected his ability to concentrate. As noted above, the phrase "productive of economic inadaptability" under the rating criteria includes consideration of being capable of producing economic inadaptability. Pierce, 18 Vet. App. at 446. Here, the evidence reflects that the Veteran's headaches were at least capable of impairing his ability to work. Accordingly, the Board finds that the Veteran's headaches were manifested by very frequent completely prostrating attacks that produce severe economic inadaptability throughout the entire period on appeal, and as such, an initial 50 percent rating is warranted.

The 50 percent rating for headaches under Diagnostic Code 8100 is the maximum schedular rating available under that diagnostic code. AB v. Brown, 6 Vet. App. 35, 38-39 (1993). The Veteran and his attorney have not raised the question of whether a higher rating is warranted on an extraschedular basis, nor does the record reflect such an extraordinary disability as to warrant extraschedular referral specifically for headaches, to include frequent hospitalization. 38 C.F.R. § 3.321. Accordingly, no further discussion of referral for an extraschedular rating is required.

 

J. Kirby

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Bryan, 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.