MIGRAINE

A. ISHIZAWAR · 2026 · Case ID: A26040287

DENIED

Summary

The veteran, who served in the Army from May 1985 to May 1992, appeals the denial of an increased disability rating for migraine headaches beyond the 30 percent rating already granted. The veteran sought a 50 percent rating, which is the highest schedular rating under Diagnostic Code 8100, requiring very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability. The Board reviewed evidence including the veteran's lay statements, VA treatment records, and a December 2023 VA examination. The veteran's reports of headache frequency and severity varied significantly, with some reports indicating daily migraines but only one or two severe occurrences per month, while later reports indicated three headaches per week. Crucially, the VA examiner found the veteran did not experience characteristic prostrating attacks and that the condition did not impact his ability to work. Furthermore, VA treatment records in April 2024 showed the veteran denied headaches on two occasions. The Board found the objective medical evidence, particularly the VA examination and the veteran's own denials of symptoms in treatment records, to be the most credible. The Board concluded that the veteran's symptoms were not completely prostrating, not prolonged, and did not result in severe economic inadaptability, especially given his continued employment as a bus driver and his recent commercial driver's license certification. The Board found the facts distinguishable from Pierce v. Principi, where a veteran's economic inadaptability was more clearly demonstrated. Therefore, the Board denied the increased rating, finding the evidence persuasively weighed against the claim.

Rationale

Veteran's reported symptoms varied significantly over time.; VA examination found no characteristic prostrating attacks or impact on work.; Contemporaneous objective medical evidence, including VA treatment records and the VA examiner's findings, was found more credible.; Symptoms not shown to be completely prostrating or prolonged.; Veteran's continued employment as a bus driver and career change demonstrate economic adaptability, not severe economic inadaptability.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8100

Docket No.

260106-620733

Full Decision Text

Citation Nr: A26040287
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 260106-620733
DATE: April 29, 2026

ORDER

Entitlement to an increased initial disability rating in excess of 30 percent for migraine headaches is denied.

FINDING OF FACT

The evidence persuasively weighs against a finding that the Veteran's migraine headaches are manifested by very frequent completely prostrating and prolonged attacks productive of, or capable of producing, severe economic inadaptability.

CONCLUSION OF LAW

The criteria for an initial disability rating in excess of 30 percent for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8100.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served active duty in the Army from May 1985 to May 1992.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which increased the Veteran's disability rating for migraine headaches to 30 percent, effective October 27, 2023. Notably, the January 2025 rating decision was a Higher-Level Review (HLR) decision, issued in response to a September 2024 VA Form 20-0996, Decision Review Request: HLR, which requested review of a March 2024 rating decision that granted service connection for migraine headaches, rated 0 percent, effective October 27, 2023.

In the January 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 March 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 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.

Entitlement to an increased initial disability rating in excess of 30 percent for migraine headaches.

Migraine headaches are rated pursuant to 38?C.F.R. §?4.124a, DC 8100. Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. 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).

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 contains 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 (2004).

The Veteran is in receipt of a 30 percent disability rating for migraine headaches for the period on appeal beginning October 27, 2023.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the Veteran's claim for an increased initial rating in excess of 30 percent for migraine headaches. The reasons follow.

Prior to the period on appeal, the Veteran presented to VA with a new complaint of headaches in April 2022. He reported recurrent headaches without a known etiology, although blood pressure and vision issues were speculated as potential causes. He reported that he was working on earning his commercial driver's license to become a truck driver. A 2022 CT image of the Veteran's head demonstrated no acute intracranial abnormality.

In November 2023, the Veteran submitted a VA Form 21-4138, Statement in Support of Claim, in which he reported experiencing daily migraine headaches. He stated that, at least a couple times a month, they "knock[ed] [him] out of commission to the point that [he was] totally incapacitated and unable to do any normal activities for [one] hour." The Veteran stated that he had about one to two severe headaches per week and that he would lie down at times, but he could not afford to miss work.

VA treatment records during this period show that the Veteran lived alone and remained physically active. He retired from his job as a lab technician at VA earlier in 2023, but continued to work as a bus driver. He exhibited normal neurological and cognitive functioning.

The Veteran underwent a VA headaches examination in December 2023. The Veteran reported experiencing headaches for about six years, increasing in frequency. He reported experiencing headaches about three times per week, including symptoms of nausea, changes in vision, and sensitivity to light and sound. He noted that he would have to lay down and relax until it passed. He denied taking medication. The examiner found that the Veteran did not experience characteristic prostrating attacks of migraine headache pain and that he did not experience completely prostrating and prolonged attacks of migraine pain. The examiner also found that the condition did not impact the Veteran's ability to work.

VA treatment records during the appeal period do not show treatment for headaches, despite receiving treatment for separate conditions and being provided multiple physical examination. Rather, on two separate occasions in April 2024, the Veteran denied headaches.

The Veteran's representative contends that the Veteran's November 2023 statement and December 2023 VA examination support an increased rating of 50 percent because they demonstrate more than one characteristic prostrating attack per month and, in fact more than one characteristic prostrating attack per week.

The Board does not find the severity of the Veteran's condition to warrant an increased 50 percent rating, which contemplates very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The December 2023 examination report does not indicate the Veteran to experience characteristic prostrating attacks.

While the Veteran's lay statements have been considered herein, his own reports of symptoms in the record have varied considerably over a short period of time. In November 2023, he reported daily migraines, but only one or two severe occurrences per month, with the use of over-the-counter medication. He reported that he may lie down at times, but that he could not miss work. The following month on examination, he reported just three headaches per week, without the use of medication, and that he laid down and relaxed until it passed. VA treatment records in 2024 show that the Veteran did not report headaches and, rather, denied headache symptoms.

Within the context of the Veteran's variance in reported symptoms, it is of particular importance to note that the severity of symptoms reported by the Veteran is not supported by the contemporaneous objective medical findings of record, including findings made by the December 2023 VA examiner and the Veteran's denial of symptoms thereafter. For these reasons, the contemporaneous objective medical evidence documented by observing practitioners is found to be the most credible evidence in the present case.

The Veteran's symptoms are not shown to be "completely prostrating" as defined herein. While the Veteran has reported that he needs to lie down to experience full symptom relief, he has indicated that he lies down when circumstances allow, because he is unable to miss work, demonstrating that he continued to work as necessary as a bus driver even during his severe headaches. To the extent that that the Veteran reported being incapacitated by his symptoms approximately twice per month, these episodes were not "prolonged," as defined herein, as the Veteran reported his symptoms to resolve in approximately an hour or less. Furthermore, the evidence does not support that the Veteran's condition resulted in severe economic inadaptability, as he has continued to work as a bus driver throughout the period on appeal. For these reasons, the evidence does not support an increased initial rating in excess of 30 percent.

The record shows the Veteran to have an associate's degree and that he earned his commercial driving certification in 2022 to become a truck driver. While employment does not preclude a finding of severe economic inadaptability, the Veteran's ongoing successful employment as a bus driver indicates that the Veteran would not be precluded from a large range of jobs that involve driving, or separate sedentary employment, comprising a vast range of jobs available to the Veteran, particularly in light of his college degree. His recent training and career change demonstrates that he has remained occupationally adaptable. The criteria for a 50 percent rating for migraine headaches require that all elements be met - very frequent and completely prostrating and prolonged attacks productive of, or capable of producing, severe economic inadaptability.

The Board acknowledges that, in Pierce, the Court explained that DC 8100 does not require the inability to work, and the phrase "productive of severe economic inadaptability" in DC 8100 should be construed as either "producing" or "capable of producing" economic inadaptability. 18 Vet. App. at 445 (2004). The Board finds it necessary to distinguish the circumstances in Pierce, in which the Court found that, in concluding that the veteran's headaches did not produce severe economic inadaptability, the Board merely listed the evidence it considered without analyzing how that evidence related specifically to the term "severe economic inadaptability." Additionally, the Court in Pierce found the Board had failed to consider the most recent information of record regarding the veteran's headache symptomology and the veteran's employment status. Id. at 445. Regarding this evidence, the Court stated that, "in the context of evaluating his headaches, the Board failed to consider the [veteran]'s January 17, 2001, letter stating that he was unemployed, had had only three job interviews, and had been able to leave his house only three times in January 2001." Id. at 446.

The facts of the present Veteran's case are distinguishable from those in Pierce, as the Veteran is shown to have maintained employment during the period on appeal. The Board understands that nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Id. As stated above, the Board does not find the evidence supports that the Veteran's symptoms would be capable of producing severe economic inadaptability, as the Veteran has proven himself to be adaptable, an attribute that would serve the Veteran even in hypothetical scenarios that are speculative in
unemployed, had had only three job interviews, and had been able to leave his house only three times in January 2001." Id. at 446.

In this instance, the Veteran's ability to change careers and maintain employment is evidence demonstrating the Veteran's economic adaptability, and does not support a finding that the Veteran's headache condition has produced or is capable of producing severe economic inadaptability. Additionally, unlike the Board's decision in Pierce, the Board herein has provided a detailed analysis of how the evidence, showing the Veteran's demonstrated functional abilities, does not support contentions of severe economic inadaptability. The Board finds the evidence persuasively weighs against a finding that the Veteran's migraine headaches are manifested by very frequent, completely prostrating and prolonged attacks productive of, or capable of producing, severe economic inadaptability.

Therefore, even after resolving all reasonable doubt in the Veteran's favor, an initial rating higher than 30 percent is not warranted for service-connected migraine headaches. The Veteran's headache symptoms are not shown to result in very frequent completely prostrating and prolonged attacks productive of, or capable of producing, severe economic inadaptability.

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For all the reasons stated herein, the weight of the evidence persuasively weighs against an award of an increased initial rating for migraine headaches in excess of 30 percent. As the evidence persuasively weighs against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran's claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3.

A. ISHIZAWAR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Wonderling, Gabriel N.

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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