MIGRAINE

GAYLE STROMMEN · 2026 · Case ID: A26040500

MIXED

Summary

The Veteran, an Army Cannon Crewmember who served from September 2002 to July 2003 and August 2008 to September 2009, appeals decisions denying service connection for several conditions and seeking review of remanded issues. The Board granted service connection for migraines and fibromyalgia, presumptively due to Persian Gulf toxic exposure, based on a January 2023 VA Memorandum verifying his Persian Gulf Veteran status and an October 2020 VA examination diagnosing these conditions as qualifying chronic disabilities. Service connection for bilateral knee disability, low back disability, bilateral lower extremity radiculopathy secondary to the low back condition, and acquired psychiatric disability (anxiety) were also granted. The Board found the Veteran's lay statements credible regarding in-service knee and back use, consistent with his MOS, and relied on a May 2024 private medical opinion linking these conditions to service. The secondary connection for radiculopathy was granted based on the established low back disability. The psychiatric claim was granted based on a May 2024 VA examination finding a credible in-service stressor (weapon misfire) and a positive nexus to anxiety. However, claims for traumatic brain injury (TBI), vertigo, cervical spine disability, bilateral upper extremity radiculopathy secondary to cervical spine disability, and erectile dysfunction were remanded due to pre-decisional errors. The TBI and vertigo claims were remanded for new VA examinations to assess etiology and nexus, as the initial examinations were inadequate or missing. The cervical spine claim was remanded due to an inadequate VA examination with contradictory findings. The upper extremity radiculopathy and vertigo claims were remanded as inextricably intertwined with the TBI and cervical spine claims. The erectile dysfunction claim was remanded due to a duty to assist error, as service hospital records from Ft. Sill, Oklahoma, and National Guard unit records were not collected.

Rationale

Persian Gulf Veteran status verified by DoD data.; Migraines diagnosed in Oct 2020 VA exam.; Migraines considered qualifying chronic disability under 38 C.F.R. § 3.317.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250501-539714

Full Decision Text

Citation Nr: A26040500
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250501-539714
DATE: April 30, 2026

ORDER

Entitlement to service connection for migraine headaches to include as secondary to Persian Gulf War toxic exposure is granted.

Entitlement to service connection for fibromyalgia claimed as bilateral hip disability to o include as secondary to Persian Gulf War toxic exposure is granted.

Entitlement to service connection for a bilateral knee condition is granted.

Entitlement to service connection for low back disability is granted.

Entitlement to service connection for bilateral lower extremity radiculopathy to include as secondary to a low back disability is granted.

Entitlement to service connection for acquired psychiatric disability to include anxiety is granted.

REMANDED

Entitlement to service connection for traumatic brain injury (TBI) is remanded.

Entitlement to service connection for vertigo is remanded.

Entitlement to service connection for a cervical spine disability is remanded.

Entitlement to service connection for bilateral upper extremity radiculopathy to include as secondary to a cervical spine disability is remanded.

Entitlement to service connection for erectile dysfunction is remanded.

FINDINGS OF FACT

1. The Veteran has been diagnosed with migraines which are presumed to have been caused by his exposure to fine, particulate matter in Southwest Asia.

2. The Veteran has been diagnosed with fibromyalgia which is presumed to have been caused by his exposure to fine, particulate matter in Southwest Asia.

3. The Veteran's bilateral knee disability is at least as likely as not related to his active duty service.

4. The Veteran's low back disability is at least as likely as not related to his active duty service.

5. The Veteran's bilateral lower extremity radiculopathy disability is at least as likely as not related to his service-connected low back disability.

6. The Veteran's acquired psychiatric disability is at least as likely as not related to his active duty service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for migraines have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.320.

2. The criteria for entitlement to service connection for fibromyalgia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.320.

3. The criteria for service connection for bilateral knee disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

4. The criteria for service connection for a low back disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

5. The criteria for a secondary service connection for a bilateral lower extremity radiculopathy have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310.

6. The criteria for service connection for an acquired psychiatric disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from September 2002 to July 2003 and from August 2008 to September 2009.

The Appeals Modernization Act (AMA) creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. The AMA became effective on February 19, 2019, and applies to all initial decisions issued after this date. 38 C.F.R. § 3.2400 (a)(1).

The initial decisions in this case were issued September 2024, October 2024, and December 2024; thus, this decision has been written consistent with the AMA framework.

The Veteran in May 2025 submitted a Board Appeal Notice of Disagreement (VA Form 10182) following a September 2024, an October 2024, and a December 2024 rating decision. The Veteran in his May 2025 appeal chose the "Direct Lane." As explained on Form 10182, per the Direct Lane," the review is based only on evidence of record at the time of September 2024, October 2024, and December
.F.R. § 3.2400 (a)(1).

The initial decisions in this case were issued September 2024, October 2024, and December 2024; thus, this decision has been written consistent with the AMA framework.

Based on review of the record, the Board has recharacterized the Veteran's claim for service connection for posttraumatic stress disorder (PTSD) as an acquired psychiatric disability and his claim for service connection for a bilateral hip disability as a claim for service connection for fibromyalgia. See Clemons v. Shinseki, 23 Vet. App. 1 (2009)

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310 (a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. See 38 C.F.R. § 3.310 (b); Allen v. Brown, 8 Vet. App. 374 (1995).

In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra.

Persian Gulf Veterans & Service Connection

Service connection may be granted for a Persian Gulf veteran with objective indications of a qualifying chronic disability. Prior to August 10, 2022, the date of the enactment of the PACT Act, service connection was warranted so long as the objective symptoms occurred either during service in the Southwest Asia Theater or manifested to a degree of 10 percent or more not later than December 31, 2026, and cannot be attributed to any known clinical cause. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. On or after August 10, 2022, the manifestation period and the degree to which a qualifying chronic disability must manifest were eliminated.

For a Veteran with service in the Southwest Asia Theater of operations during the Persian Gulf War, service connection may be established under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Service connection may be warranted for a Persian Gulf Veteran with objective indications of a qualifying chronic disability.

A "qualifying chronic disability" may be one that results from an "undiagnosed illness" or a "medically unexplained chronic multisymptom illness". 38 U.S.C. §1117 (a)(2)(A), (B); 38 C.F.R. § 3.317 (a)(2)(ii). A medically unexplained chronic multisymptom illness (MUCMI) that is defined by a cluster of signs or symptoms includes fibromyalgia and headaches. 38 C.F.R. § 3.317 (a)(2)(i)(B).

A January 2023 VA Memorandum states that the Department of Defense (DoD) has provided VA with authoritative data that verifies the Veteran meets the definition of a "Persian
be one that results from an "undiagnosed illness" or a "medically unexplained chronic multisymptom illness". 38 U.S.C. §1117 (a)(2)(A), (B); 38 C.F.R. § 3.317 (a)(2)(ii). A medically unexplained chronic multisymptom illness (MUCMI) that is defined by a cluster of signs or symptoms includes fibromyalgia and headaches. 38 C.F.R. § 3.317 (a)(2)(i)(B).

A January 2023 VA Memorandum states that the Department of Defense (DoD) has provided VA with authoritative data that verifies the Veteran meets the definition of a "Persian Gulf Veteran" as specified by 38 U.S.C. § 1117 and 38 C.F.R. § 3.317(e).

1. Entitlement to service connection for migraine headaches to include as secondary to Persian Gulf War toxic exposure.

The Veteran was diagnosed with migraines in an October 2020 VA examination. This examiner found that the Veteran's headaches were diagnosable, but medically unexplained chronic multi-symptom illness of unknown etiology, and thus it is a qualifying chronic disability under 38 C.F.R. § 3.317. The Board notes that headaches are specifically listed as a sign or symptoms which may be manifestations of an undiagnosed illness or MUCMI. 38 C.F.R. § 3.317(a)(2)(i)(B)(3). Furthermore, in the October 2020 VA examination, the examiner remarked that the Veteran's migraine headaches were part of an undiagnosed chronic illness.

The foregoing evidence shows that the Veteran is a "Persian Gulf War Veteran" who manifests a "qualifying chronic disability" (migraine headaches) for presumptive service connection purposes. See 38 C.F.R. § 3.317 (a)(2)(i)(B)(2). Thus, service connection for migraines due to exposure to toxins in Southwest Asia Theater of Operations is granted.

2. Entitlement to service connection for fibromyalgia, claimed as bilateral hip disability, to o include as secondary to Persian Gulf War toxic exposure.

The Veteran was diagnosed with fibromyalgia in an October 2020 VA examination.

The foregoing evidence shows that the Veteran is a "Persian Gulf War Veteran" who manifests a "qualifying chronic
2026, and cannot be attributed to any known clinical cause. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. On or after August 10, 2022, the manifestation period and the degree to which a qualifying chronic disability must manifest were eliminated. Here, the Veteran's claim for service connection was submitted in a May 2024 application for a fully-developed claim. Thus, the more liberal provisions of the PACT Act apply to the Veteran's claim.

The Veteran was diagnosed with fibromyalgia in an October 2020 VA examination.

The foregoing evidence shows that the Veteran is a "Persian Gulf War Veteran" who manifests a "qualifying chronic disability" (fibromyalgia) for presumptive service connection purposes. See 38 C.F.R. § 3.317 (a)(2)(i)(B)(2). Thus, service connection for fibromyalgia due to exposure to toxins in Southwest Asia Theater of Operations is granted.

3. Entitlement to service connection for a bilateral knee condition.

At the onset, the Board notes that there is no dispute that the Veteran has a current bilateral knee disability as noted in the favorable findings of the September 2024 rating decision.

Regarding inservice incurrence, the Veteran in a May 2024 correspondence wrote that he had to endure heavy and repeated use of his knees while on active duty. The Board recognizes that the Veteran' military occupational specialty (MOS) was a Cannon Crewmember. The Board finds that the Veteran's statements to be credible as they are consistent with nature of his service as a Cannon Crewmember. As the matter of a current disability and injury have been resolved the only remaining issue is a matter of nexus.

Turning to the nexus, the Board finds that the May 2024 private medical opinion is probative on this matter. In this private medical opinion, the physician summarized the nature of the Veteran's service and used this information to form his positive opinion which related the Veteran's inservice knee injuries to his current bilateral knee disability. Thus, service connection for bilateral knee disabilities is granted.

4. Entitlement to service connection for low back disability.

At the onset, the Board notes that there is no dispute that the Veteran has a current low back disability as noted in the favorable findings of the September 2024 rating decision.

Regarding inservice incurrence, the Veteran in a May 2024 correspondence wrote that he had to endure heavy and repeated use of his back while on active duty. The Board recognizes that the Veteran' military occupational specialty (MOS) was a Cannon Crewmember. The Board finds that the Veteran's statements to be credible as they are consistent with nature of his service as a Cannon Crewmember. As the matter of a current disability and injury have been resolved the only remaining issue is a matter of nexus.

Turning to the nexus, the Board finds that the May 2024 private medical opinion is probative on this matter. In this private medical opinion, the physician summarized the nature of the Veteran's service and used this information to form his positive opinion which related the Veteran's inservice back use to his current low back disability. Thus, service connection for a low back disability is granted.

5. Entitlement to service connection for bilateral lower extremity radiculopathy as secondary to a low back disability.

At the onset, the Board notes that there is no dispute that the Veteran currently diagnosed with a bilateral lower extremity radiculopathy disability as noted in the favorable findings of the September 2024 rating decision.

The Veteran is now service connected for a low back disability as noted above. Thus, the only remaining issue is a nexus between his bilateral radiculopathy and his service-connected low back disability.

On the issue of nexus, the Board finds that there is no dispute that the Veteran's lower extremity radiculopathy is caused by his low back disability as found the September 2024 rating decision's favorable findings.

Considering the foregoing, the Board finds that all the elements of secondary service connection have been met, and service connection for the Veteran's bilateral lower extremity radiculopathy as secondary to his service-connected low back disability is granted.

6. Entitlement to service connection for acquired psychiatric disability to include anxiety.

At the onset, the Board recognizes that there is no dispute that the Veteran has a current disability as noted in the September 2024 rating decision's favorable findings which noted that the Veteran was diagnosed with an unspecified anxiety disorder.

The Board notes that the Veteran was provided with a May 2024 VA examination wherein the examiner concluded that the Veteran experienced a stressor event in service. Namely, a misfire of his vehicle's weapon in training that led to an explosion. The Board recognizes that the Veteran MOS was that of a cannon crewman and accepts that the incident is consistent with the nature and circumstances of his service
secondary to his service-connected low back disability is granted.

6. Entitlement to service connection for acquired psychiatric disability to include anxiety.

The Board notes that the Veteran was provided with a May 2024 VA examination wherein the examiner concluded that the Veteran experienced a stressor event in service. Namely, a misfire of his vehicle's weapon in training that led to an explosion. The Board recognizes that the Veteran MOS was that of a cannon crewman and accepts that the incident is consistent with the nature and circumstances of his service. Therefore, the Board find the Veteran's statement credible and an in service stressor event established.

Turning to a nexus, the Board acknowledges that the May 2024 VA examiner provided a positive nexus linking the Veteran's anxiety disability to the incident in service. It is clear upon review that the VA examiner accurately summarized the nature of the Veteran's service, provided a thorough examination of the Veteran's mental health, and used this information to form his positive opinion.

Considering the foregoing, the Board finds that the most probative evidence of record is in favor of the claim, thus service connection for an unspecified anxiety disability is granted.

REASONS FOR REMAND

1. Entitlement to service connection for traumatic brain injury (TBI) is remanded.

A pre-decisional error has been committed as the Veteran has not yet been provided with a VA examination to determine the etiology of his claim of a traumatic brain injury. The Veteran's statement about being exposed to an explosion and his MOS in the military as a cannon crewman provided persuasive evidence that warrant further investigation by a competent medical professional. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board is not competent to determine a diagnosis or etiology of the Veteran's claimed traumatic brain injury. The fact that the Veteran was not provided a VA examination amounts to a pre-decisional duty-to-assist error and, as such, a VA examination is warranted.

2. Entitlement to service connection for a cervical spine disability is remanded.

A pre-decisional error has been committed as the October 2024 VA examination for the Veteran's cervical spine disability was, in part, inadequate.

Upon review of the October 2024 VA examination, the Board notes that the VA examiner's rationale contradicts itself. He first notes there is no evidence of an injury in service, but then recognizes the Veteran's lay statement surrounding an injury. Then, he ultimately concludes that there is no nexus because of a lack of continued medical care for any neck injury. This type of rationale however has been addressed by the Court of Appeals for Veterans Claims (Court), which has held, in short, that "symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." in Savage v. Gober, 10 Vet. App. 488, 496 (1997). Thus, the Board finds that the VA examination is, in part, inadequate. The Court has held that that once VA undertakes the effort to provide an examination when developing a claim, even if not statutorily obligated to do so, VA must ensure that the examination provided is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). Considering the foregoing, the Board finds a new VA examination is warranted.

3. Entitlement to service connection for bilateral upper extremity radiculopathy to include as secondary to a cervical spine disability is remanded.

4. Entitlement to service connection for vertigo is remanded.

The Veteran's claim for a service connection for bilateral upper extremity radiculopathy is inextricably intertwined with the claim of service connection for a cervical spine disability and the Veteran's claim for vertigo is inextricably intertwined with his claim for a TBI as the development requested in connection with the above claims could have direct bearing on the Veteran's claims for these conditions. Hence, this final issue is not yet ripe for appellate review and must be deferred pending readjudication of those other remanded claims. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that two or more issues are inextricably intertwined if the disposition of one claim could have a significant impact on the outcome of another).

5. Entitlement to service connection for erectile dysfunction is remanded.

The Board also recognizes that a pre-decisional duty to assist error has occurred as the Veteran has identified service hospital records that the AOJ has
, this final issue is not yet ripe for appellate review and must be deferred pending readjudication of those other remanded claims. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that two or more issues are inextricably intertwined if the disposition of one claim could have a significant impact on the outcome of another).

5. Entitlement to service connection for erectile dysfunction is remanded.

The Board also recognizes that a pre-decisional duty to assist error has occurred as the Veteran has identified service hospital records that the AOJ has not yet attempted to collect. In particular, the Veteran in his May 2024 correspondence wrote that he experienced a malfunction of a cannon while in service and was taken to the medical center at "Ft. Sill" for treatment and observation. In a separate May 2024 correspondence, the Veteran further details that he was taken to Ft. Sill in Oklahoma in or around June 1, 1989. Additionally, the Board observes that the claims file did not contain a military personnel records. In addition to the Veteran's military service in the United States Army the Veteran had substantial service in the Army National Guard of Oklahoma as found in a December 23, 2019 "Report of Separation and Record of Service" document. The AOJ should collect these records as they may be pertinent to the Veteran's claim.

The matters are REMANDED for the following action:

1. The AOJ should ensure that all military personnel records, service treatment records and service hospital records from verified active service have been associated with the claims file.

(A) In particular, the Board is interested in any service hospital records which were created when the Veteran was treated at a Ft.Sill, Oklahoma on or around June 1, 1989s. The AOJ should contact the U.S. Department of Army, Records Management and Declassification Agency (RMDA) to obtain any outstanding records.

(B) In particular, a request should be made for the Veteran's National Guard unit records from the Army National Guard of Oklahoma from August 1983 to February 2001.

2. After the above development, schedule the Veteran for appropriate VA examinations to address his claims. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiners as part of the examination. All tests, studies, and evaluations should be performed as deemed necessary by the examiners, and the results of any testing must be included in the examination report.

(A) TRAUMATIC BRAIN INJURY:

(i) After considering the pertinent information in the record in its entirety and taking a detailed history from the Veteran regarding onset, the VA examiner should identify any TBI present.

(ii). Then, the examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any TBI identified were incurred or aggravated by his active duty or are otherwise etiologically related to his active service, to include the Veteran's report of being exposed to an explosion in service. Explain why or why not.

(B) CERVICAL SPINE:

(i) After considering the pertinent information in the record in its entirety and taking a detailed history from the Veteran regarding onset, the VA examiner should identify any cervical spine disability present.

(ii). Then, the examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any cervical spine disability identified were incurred or aggravated by his active duty or are otherwise etiologically related to his active service. Explain why or why not.

3. Ensure that the examination reports comply with this remand and the questions presented in this request.

4. Then, readjudicate the issues on appeal.

GAYLE STROMMEN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Acosta, J.

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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