MIGRAINE

Summary

The Veteran served from February 2001 to September 2001 and again from January 2005 to December 2005. The Veteran appealed the denial of service connection for migraine headaches, claiming they were either directly related to in-service head injuries or secondary to his service-connected PTSD and tinnitus. The Board found no direct service connection, as the Veteran's service treatment records did not diagnose a headache disorder, and the Veteran, a surgical technician, lacked the expertise to link headaches to service without medical opinion. However, the Board found sufficient evidence for secondary service connection. A private physician, Dr. E.M., provided a detailed opinion in November 2024, diagnosing migraine headaches and linking them to the Veteran's PTSD and tinnitus, citing shared physiological and psychological pathways and supporting literature. Conversely, a VA examiner in April 2025 found no current migraine diagnosis and opined the condition was less likely than not related to service, citing conflicting reports and a lack of chronic disability evidence. The Board found Dr. E.M.'s opinion more persuasive, noting the Veteran's reports of intermittent headaches and migraines in VA treatment records, and his co-worker's corroboration. Resolving doubt in the Veteran's favor, the Board granted service connection for migraine headaches as secondary to his service-connected PTSD and tinnitus.

Rationale

Private physician's opinion found causal and aggravating relationship between PTSD/tinnitus and migraines.; VA treatment records and co-worker corroborated reports of headaches/migraines.; Resolving doubt in Veteran's favor due to conflicting medical opinions.

Full Decision Text

Citation Nr: A26040383
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 251023-601449
DATE: April 29, 2026

ORDER

Service connection for migraine headaches is granted.

FINDING OF FACT

Resolving all reasonable doubt in the Veteran's favor, his currently diagnosed migraine headaches are proximately due to his service-connected posttraumatic stress disorder with alcohol use disorder (PTSD) and tinnitus.

CONCLUSION OF LAW

The criteria for service connection for migraine headaches have been met. 38 U.S.C. 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from February 2001 to September 2001 and January 2005 to December 2005 with additional service in the National Guard. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in April 2025 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA). In October 2025, the Veteran timely appealed such rating decision by filing a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ).

Therefore, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. However, based on the evidence the Board may consider, service connection for migraine headaches is awarded herein, which is a full grant of the benefit sought on appeal.

The Board observes that, in his October 2025 VA Form 10182, the Veteran also attempted to appeal the denial of service connection for a back disorder; however, such claim was most recently denied in a December 2022 rating decision. Thus, as the Veteran did not file a request for an extension of time to submit his notice of disagreement based on good cause in a timely manner, and his notice of disagreement was received more than one year after the issuance of the December 2022 rating decision, it is untimely. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.104, 20.201, 20.202, 20.203, 20.204. Further, the AOJ has not waived the requirement to timely file a notice of disagreement, and the Board declines to do so. Hall v. McDonough, 34 Vet. App. 329, 332 (2022); Ferko v. McDonough 37 Vet. App. 262 (en banc); Percy v. Shinseki, 23 Vet. App. 37, 45 (2009). Thus, such matter is not properly before the Board and will not be addressed herein.

Entitlement to service connection for a headache disorder, to include as secondary to service-connected PTSD and tinnitus. 

The Veteran contends that he has a headache disorder that is directly related to his military service as a result of multiple in-service head injuries and concussive blasts. He also alleges, in the alternative, that he developed headaches after he had PTSD and tinnitus, and indicated that increased stress, anxiety, flashbacks, intrusive memories, and tinnitus trigger the occurrence of such headaches.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Service connection may also be granted for any disease 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).  Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury.  Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).  

Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as organic diseases of the nervous
 incurred in service.  38 C.F.R. § 3.303(d).  Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury.  Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).  

Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as organic diseases of the nervous system, which includes migraine headaches, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).  Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability.  38 C.F.R. § 3.310(b); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding all that is needed is a "but for" causation or aggravation to show entitlement to secondary service connection).

While the Veteran's service treatment records (STRs) reflect his complaint of headaches, which were diagnosed as headaches, an ear infection, and diarrhea, during periods of training in July 1998 and January 2001, and included related symptoms of a cough, low grade fever, congestion, and sore throat in September 2005, no headache disorder was diagnosed in service or within one year of his separation from a period of active duty. Furthermore, the Veteran, while working as a surgical technician, has no reported or documented expertise in neurology and, thus, he is not competent to relate a headache disorder to any aspect of his military service as such is a complex medical matter outside the scope of his expertise, and there is no competent medical opinion relating such disorder to his military service. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Thus, service connection for a headache disorder on a direct or presumptive basis is not warranted.

With respect to secondary service connection, an October 2020 VA treatment record reflects the Veteran's report of experiencing headaches in relation to his tinnitus, and a December 2024 VA treatment record reveals that he was noted to have migraines from time to time. Similarly, in April 2025, his co-worker, a nurse, reported that he experienced recurring migraine headaches.

Additionally, a November 2024 Disability Benefits Questionnaire completed by Dr. E.M., a private physician, reflects a diagnosis of migraine headaches. It was also noted that the Veteran reported that he did not develop migraines until after incurring PTSD and tinnitus, and he indicated that increased stress, anxiety, flashbacks, intrusive memories, and tinnitus trigger the occurrence of such headaches. Dr. E.M. opined that the combination of the Veteran's PTSD and tinnitus is the
 relation to his tinnitus, and a December 2024 VA treatment record reveals that he was noted to have migraines from time to time. Similarly, in April 2025, his co-worker, a nurse, reported that he experienced recurring migraine headaches.

Additionally, a November 2024 Disability Benefits Questionnaire completed by Dr. E.M., a private physician, reflects a diagnosis of migraine headaches. It was also noted that the Veteran reported that he did not develop migraines until after incurring PTSD and tinnitus, and he indicated that increased stress, anxiety, flashbacks, intrusive memories, and tinnitus trigger the occurrence of such headaches. Dr. E.M. opined that the combination of the Veteran's PTSD and tinnitus is the most likely cause of his neurologic symptoms and, at the very least, had exacerbated and worsened his headache disorder. In support thereof, she indicated that, through clinical research, case studies, and clinical reports, PTSD, tinnitus, and headache disorders, namely migraine headaches, have been shown to share multiple complex pathways that contribute to their development and worsening. She further noted that there are multiple physiological and psychological pathways that these conditions share, which ultimately very likely led to one condition causing the onset of the other. 

Dr. E.M. cited several studies that explored the relationship between tinnitus and headaches. For example, one study showed that individuals with tinnitus and comorbid headaches experienced a lower quality of life and more severe symptoms related to both conditions. Another study argued against a purely coincidental cooccurrence of tinnitus and headaches, and it found that the two disorders likely had common pathophysiological mechanisms, and a third study showed that both conditions can worsen the other. 

Dr. E.M. also cited other studies that explored the relationship between PTSD and headaches. For example, one study found multiple mechanisms for a possible causal relationship between PTSD and headaches. In patients with PTSD, key neurotransmitters (namely serotonin and norepinephrine) are low, and such is also found in people with migraines. PTSD patients have abnormal cortisol levels, which people with migraines share as well. Another study found that headaches were a component of PTSD, and an additional study found that depression likely aggravates or increases central sensitization, thus increasing an individual's vulnerability for tension-type headaches. Here, it was observed that depression primed the patient's body to experience tension headaches and also worsened the severity of the headaches. She further noted that another study found a bidirectional causal relationship between headaches and depression or anxiety. 

Dr. E.M. further cited several studies discussing the incidence of migraines and headaches within the veteran population. One study found a strong association between migraines and psychiatric disorders among veterans. 

Ultimately, Dr. E.M. found that the evidence, including the medical literature, showed both a causal and aggravating relationship between the Veteran's service-connected PTSD and tinnitus and his headache disorder. She stated that the Veteran's PTSD and tinnitus had been shown to have a bidirectional causal relationship between such service-connected disabilities and the diagnosis of a headache disorder. She further indicated that, after reviewing the evidence of record, she believed that there existed a clear nexus between the Veteran's event in service and his present diagnosed migraine headaches. Dr. EM also stated that he believed that the Veteran's condition was highly likely to be secondary and a direct result of his established service-connected event. 

Conversely, at an April 2025 VA examination, the examiner found that the Veteran did not have a current diagnosis of a headache disorder, and opined that such claimed disorder was less likely than not proximately due to or the result of the Veteran's service-connected PTSD and tinnitus. Here, he stated that the objective medical evidence is not consistent with a chronic migraine disability or congruent with Dr. E.M.'s November 2024 opinion. 

Specifically, the examiner stated that the aforementioned October 2020 VA treatment record, which reflected the Veteran's report of experiencing headaches, also indicated that he denied having headaches. He also observed that he denied having headaches in other VA treatment records and, while the December 2024 VA treatment record reflected the Veteran's report of having migraines from time to time, which were followed by his primary care provider, he found that such was neither consistent with the history above nor the presence of a chronic disability despite a drastically different picture painted by Dr. E.M. Ultimately, the examiner stated that the medical evidence did not support the Veteran's migraine claim as he had never been diagnosed with migraine or other headache type variants. 

The examiner further stated that, aside from the October 2020 conflicting subjective endorsement and denial of headaches and the December 2024 single mention of migraine headaches more than 26 years after the Veteran entered military service (in June 1998) and nearly 19 years following separation from active service (in December 2005),
 the Veteran's report of having migraines from time to time, which were followed by his primary care provider, he found that such was neither consistent with the history above nor the presence of a chronic disability despite a drastically different picture painted by Dr. E.M. Ultimately, the examiner stated that the medical evidence did not support the Veteran's migraine claim as he had never been diagnosed with migraine or other headache type variants. 

The examiner further stated that, aside from the October 2020 conflicting subjective endorsement and denial of headaches and the December 2024 single mention of migraine headaches more than 26 years after the Veteran entered military service (in June 1998) and nearly 19 years following separation from active service (in December 2005), the evidence was silent for complaints, concerns, symptoms, signs, evaluation, diagnosis, or treatment of the Veteran's claimed migraines. He also found that Dr. E.M.'s opinion was incongruent, and it brought into question the actual authenticity of the subjective information supplied by the Veteran to a non-VA provider. Ultimately, the examiner stated that the evidence of record was not consistent with a positive medical opinion. 

While the April 2025 VA examiner found that the Veteran did not have a current diagnosis of a headache disorder, Dr. E.M. noted a diagnosis of migraine headaches. Additionally, his VA treatment records reflect, at the very least, reports of intermittent headaches, to include migraines, and his co-worker, who is a nurse, documents recurring migraine headaches. Thus, the Board resolves all reasonable doubt in favor of the Veteran and finds that he has a current diagnosis of migraine headaches. Moreover, Dr. E.M. provided a thorough, well-explained opinion relating his current migraine headaches to his service-connected PTSD and tinnitus, and there is no competent medical opinion to the contrary. Therefore, the Board resolves any remaining reasonable doubt in his favor and finds that his currently diagnosed migraine headaches are proximately due to his service-connected PTSD and tinnitus. Thus, service connection for such disorder is warranted. 38 U.S.C. §?5107; 38 C.F.R. §?3.102.

 

 

A. JAEGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Leung, Dawn

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.