MIGRAINE

Summary

The Veteran, a Marine Corps Veteran who served from August 2011 to April 2018, appeals the reduction of his disability rating for migraine headaches from 50 percent to 0 percent, effective May 10, 2021. The initial 50 percent rating was granted in June 2018, based on service treatment records and a VA examination. The reduction occurred after subsequent VA examinations in May and August 2021, which found the Veteran did not have "very prostrating and prolonged attacks" productive of severe economic inadaptability, despite noting missed work due to headaches and functional impacts. The Board reviewed the evidence of record available at the time of the reduction. The Veteran testified at a May 2025 Board hearing, stating he experiences six headaches per month, each lasting a full day and requiring him to rest in a dark room, and that he never had less frequent attacks. He also submitted an employer letter and a headache log documenting missed work and severe attacks. The Board found the VA examinations inadequate because they did not reconcile the finding of infrequent severe attacks with the Veteran's reports of frequent incapacitating headaches, missed work, and functional impacts. The Board concluded the reduction was improper and restored the 50 percent rating effective May 10, 2021.

Rationale

Reduction improper due to inadequate VA examinations; Examinations did not reconcile findings with Veteran's reports of frequent incapacitating headaches and missed work; Veteran's testimony and submitted evidence (employer letter, headache log) supported continued 50% rating

Full Decision Text

Citation Nr: A26040617
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210928-188506
DATE: April 30, 2026

ISSUE

Whether the reduction of the rating for migraine headaches from 50 percent to 0 percent effective May 10, 2021, was proper.

ORDER

The reduction of the rating for migraine headaches from 50 percent to 0 percent was improper and the 50 percent rating is restored, subject to the laws and regulations governing the payment of monetary benefits. 

FINDING OF FACT

The evidence at the time of the rating reduction did not demonstrate actual improvement of the Veteran's migraine headaches in his ability to function under the ordinary conditions of life and work. 

CONCLUSION OF LAW

The criteria for reduction of the rating for migraine headaches from 50 percent to 0 percent was improper, and the 50 percent rating is restored effective May 10, 2021.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105, 3.344, 38 C.F.R. § 4.124a, Diagnostic Code 8100. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the Marine Corps from August 8, 2011, to April 29, 2018. 

This matter comes before the Board of Veterans' Appeals (Board) from an August 2021 rating decision by a Department of Veterans Affairs (VA) Regional Office, which continued the reduction of the Veteran's disability rating for migraine headaches from 50 percent to 0 percent disabling, effective May 10, 2021. 

The Board notes that on his VA Form 10182, the Veteran did not identify the date of the decision he was appealing. The Board notes that a June 2021 rating decision reduced the Veteran's disability rating from 50 percent to 0 percent disabling for his service-connected migraine headaches effective May 10, 2021. The Veteran submitted a July 20, 2021, VA Form 20-0995 supplemental claim requesting review of this decision and subsequent to a VA examination, the Veteran's 0 percent disability rating for his headache disability was continued in the August 2021 rating decision.

As the August 2021 rating decision represents the latest rating decision in the appeal stream, encompassing the latest development by the RO, and addresses the prior decision to reduce his disability rating for migraine headaches, the Board construes the VA Form 10182 as appealing the August 2021 rating decision.

In his September 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. A Board hearing was held on May 8, 2025.  

Therefore, the Board may only consider the evidence of record at the time of the August 2021 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, the Appellant 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 claims, considering the new evidence in addition to the evidence previously considered. Id. 

Specific instructions for filing a Supplemental Claim are included with this decision.

Whether the reduction of the rating for migraine headaches from 50 percent to 0 percent was proper.

Rating Reduction Legal Criteria

A veteran's rating shall not be reduced unless an improvement in the disability is shown to have occurred.  See 38 U.S.C. § 1155.  Prior to reducing a veteran's disability, VA is required to comply with several general regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect.  See 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13; see also Brown v. Brown, 5 Vet. App. 413, 420 (1993).  These provisions impose a clear requirement that VA rating reductions be based upon review of the
Rating Reduction Legal Criteria

A veteran's rating shall not be reduced unless an improvement in the disability is shown to have occurred.  See 38 U.S.C. § 1155.  Prior to reducing a veteran's disability, VA is required to comply with several general regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect.  See 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13; see also Brown v. Brown, 5 Vet. App. 413, 420 (1993).  These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of the Veteran's disability.  See Schafrath v. Derwinski,1 Vet. App. 589, 594 (1991).  Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations.

In any rating-reduction case not only must it be determined that an improvement in a disability has actually occurred but also that the improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work.  See Faust v. West,13 Vet. App. 342, 350 (2000).  

It is essential, both in the examination and evaluation of the disability, that each be viewed in relation to its history.  38 C.F.R. § 4.1. If an examination report does not contain sufficient detail, or the diagnosis is not supported by the findings on the examination report, it must be returned as inadequate for rating purposes.  38 C.F.R. § 4.2.

Here, the 50 percent rating initially assigned to the Veteran's service-connected migraine headaches was in effect from April 30, 2018, to May 9, 2021, when the RO reduced the rating to 0 percent, a period of less than five years.  As the rating was in effect for less than five years, the provisions of 38 C.F.R. §3.344(a), (b), which provide additional regulatory hurdles to rating reductions, do not apply. 

The provisions of 38 C.F.R. § §3.344(c) provide those ratings in effect for less than five years can be reduced upon a showing that the disability has improved. 

Furthermore, the Board notes that in Stern, the Court held that although 38 C.F.R. § 3.344 applies only to ratings that have been in effect for 5 years or more, pursuant to §§ 4.2 and 4.10, in any rating-reduction case not only must it be determined that an improvement in a disability has actually occurred but also that improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work.  Stern v. McDonough, 34 Vet. App. 51 (2021).

When reduction in the rating of a service-connected disability is contemplated and the lower rating would result in a reduction or discontinuance of compensation payments, the provisions of 38 C.F.R. §3.105 provide requirements related to affording the Veteran an opportunity to present additional evidence and request to be heard on the matter.  Id. 

In this case, the RO's proposed reduction did not result in a reduction of compensation payments.

In considering whether a reduction was proper, the Board must focus on the evidence of record available to the AOJ at the time the reduction was effectuated, although post-reduction medical evidence may be considered for the limited purpose of determining whether the condition had demonstrated sustained, actual improvement.  Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992).  However, post-reduction evidence may not be used to justify an improper reduction.

Migraine Headaches

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
 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).

In rating headaches or migraines under DC 8100, the Board may not consider the ameliorative effects of medication.  See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

Discussion and Analysis

By way of background, The Veteran submitted his claim for chronic headaches, June 29, 2017 (prior to his separation from service).  See June 29, 2017, VA Form 21-526EZ.

In a December 2017 rating decision, for purposes of entitlement to Department of Veterans Affairs (VA) benefits, it was proposed to establish service connection for migraine headaches (also diagnosed as posttraumatic headaches) as directly related to military service with a 50 percent disability evaluation. 

In a June 2018 rating decision, the Veteran was granted service connection for headaches and assigned a 50 percent disability rating (the highest rating under the schedular), effective, April 30, 2018, one day following the Veteran's separation from service.

The Board notes the Veteran's initial disability evaluation was determined based on service treatment records (STR's) received by the RO for the period of service from August 8, 2011, through October 26, 2017, and a Headaches examination.

The Board noted that in an August 2017 STR, the Veteran was diagnosed with chronic migraine headaches and a history of concussion. It was noted that the service member reports that in Oct 2015, he was involved in a sports concussion while playing football. He notes that another player's chin hit him in the right temple region. He did not have any loss of consciousness at the time and did not seek immediate medical attention. Since the concussion he had headaches and was referred to the TBI clinic where he was seen and treated at speech/occupational therapy, physical and stamina therapy, vestibular therapy and completed treatment goals.  It was noted that he has CBT
 through October 26, 2017, and a Headaches examination.

The Board noted that in an August 2017 STR, the Veteran was diagnosed with chronic migraine headaches and a history of concussion. It was noted that the service member reports that in Oct 2015, he was involved in a sports concussion while playing football. He notes that another player's chin hit him in the right temple region. He did not have any loss of consciousness at the time and did not seek immediate medical attention. Since the concussion he had headaches and was referred to the TBI clinic where he was seen and treated at speech/occupational therapy, physical and stamina therapy, vestibular therapy and completed treatment goals.  It was noted that he has CBT for irritability and sleep and by April 2016 headaches were almost fully resolved and he was discharged from the TBI program. 

It was noted that in Oct 2016 he presented to his PCM for worsening headaches and reported daily headaches as well as intermittent migraines occurring 3-4 times a week, rated at a 6-7/10 in severity occurring on the right side, sharp and throbbing in sensation.  It was noted, pain lasts for several hours, and he will try to sleep and rest when this occurs. Loud noises are a direct trigger for his headaches.  It was noted that he has not been functioning in his MOS as an AC mechanic as he cannot work with the noise from the generator and therefore has been performing desk work jobs during the day. It was noted that an MRl brain performed February 4, 2017, was normal. Medication treatment history consisted of Propranolol, Topamax, Amitriptyline, Botox, alpha stim, magnesium, Imitrex, Naproxen, Zofran.  Regarding symptomatology, it was noted that the service member reports difficulty in an environment with loud sounds, such as generator noise as this triggers headaches. It was noted he cannot fire weapons as the noise also triggers pain. He also cannot perform activities which cause high impact such as running which makes his headaches worse.  It was noted he has difficulty with focus and concentration when his headaches occur.  Regarding duty limitations, it was noted that the member is non-deployable, cannot handle weapons, should not be exposed to loud noise, cannot perform PRT/CFTs.

In an August 2017 Headaches examination, an examiner noted that the Veteran experiences constant headache pain, localized to one side of the head which worsens with physical activity.  The examiner noted that the Veteran's associated symptoms consist of sensitivity to light. The examiner noted the Veteran has head pain, less than a day.  The examiner further stated that the Veteran has characteristic prostrating attacks less frequently than once per month, and that the Veteran does not have very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic adaptability.  Regarding functional impact, the examiner reported that the Veteran's headache condition resulted in decreased tolerance.

As referenced above, in a June 2018 rating decision, the Veteran was granted service connection for headaches and assigned a 50 percent disability (the highest rating under the schedular), effective April 30, 2018, the day following his separation from service.

March 2021 medical records document on medical history, the Veteran continues to get 6 migraines a week on average along with some tension headaches.  It is noted the Veteran takes Eletriptan.

A separate March 2021 medical record documents, the Veteran presents to the clinic today with secondary complaint of neck pain and headaches. It is noted he has had these since 2016, secondary to a TBI injury. It is noted, he experiences migraine headaches, around 6x per week and a tension headache a few times per day.  It is noted, the migraines are located over the right temporal region and right eye, and the tension headache is in a band like pattern around the head. It is noted that almonds and spicey foods can trigger headaches, but more the migraines than the tension headache. Loud noises can also trigger headaches.  It is noted he is on medications for the headache.  Eletriptan is his emergency medication and he also takes gabapentin.  It is noted that he has a CEFALY device and this helps.  It is noted, he tried many other medications, but they did not work as well as what he's currently on.  It is noted that he tried Botox and this also helped. He reports he would like to do it again.  It was noted that the Veteran does not have aura with the headaches, but he has trouble focusing and concentrating. It is noted he gets phonophobic, but not photophobic. It is noted, he has some nausea and sometimes can vomit due to headaches. It was noted that his
 he is on medications for the headache.  Eletriptan is his emergency medication and he also takes gabapentin.  It is noted that he has a CEFALY device and this helps.  It is noted, he tried many other medications, but they did not work as well as what he's currently on.  It is noted that he tried Botox and this also helped. He reports he would like to do it again.  It was noted that the Veteran does not have aura with the headaches, but he has trouble focusing and concentrating. It is noted he gets phonophobic, but not photophobic. It is noted, he has some nausea and sometimes can vomit due to headaches. It was noted that his hand dexterity can become altered with a severe migraine. The Veteran denies loss in grip strength, dysphagia, dysphonia, or altered sensation in the face.  It is noted that his headaches range between 4-8/10 in intensity and that sometimes, all he can do is just sleep them off. It is noted that sometimes they limit him from going to work.  It is noted that he continues to get 6 migraines a week on average along with some tension headaches; takes Eletriptan as ordered.

In April 2021, the Veteran submitted service connection claims for PTSD, and musculoskeletal pain in his upper and lower extremities.  See April 26, 2021, VA Form 21-526EZ.

The Veteran was afforded multiple VA examination, to include a Headaches examination.

In a May 2021 Headaches examination, the examiner noted the Veteran's diagnosis of migraine including migraine variants.  The examiner noted that since the last Compensation and Pension exam of 2017, he continues to report severe headaches, occurring on average 5-6x a week, triggered by spicy foods, almonds and loud noises, with onset of difficulty concentrating/ focusing then constant pain primarily in the right temporal region with sound sensitivity and occasionally nausea, rarely dizziness.  

The examiner noted that he also reports "daily headaches, like tension headaches." The examiner noted the Veteran's report of missing work 2-3 x a month from headaches.  The examiner noted the Veteran is currently in treatment for the headaches at the Bay Pines VAMC neurology department.  The examiner noted the Veteran is on medications of Nortriptyline and PRN Eletriptan and a pending a community care referral for Botox injections.   

The examiner noted that the Veteran's experiences headache pain that is constant, localized to one side of the that worsens with physical activity.  The examiner noted that the Veteran's non-headache symptoms associated with his headaches include nausea and sensitivity to sound, lasting less than a day, on the right side of the head. 

The examiner further noted that the Veteran has characteristic prostrating attacks less frequently than one in 2 months over the last several months.  The examiner noted that the Veteran does not have very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic adaptability.   Regarding functional impact, the examiner reported missing work, 2-3 x's a month due to incapacitating headaches. The examiner also noted the Veteran reports headaches associated with poor concentration and focus, which may impact him in the workplace.

The Board notes that following this May 2021 examination the Veteran's disability rating for his headache disability was decreased from 50 percent to zero percent disabling.  In July 2021, the Veteran filed a supplemental claim with this rating decision and subsequently was afforded an August 2021 records review examination.  

In an August 2021 Headaches records review examination, the examiner noted the Veteran's diagnosis of migraine including migraine variants.  The examiner noted on medical history, the Veteran's migraines started in 2016 with an unknown trigger.  The examiner noted the Veteran takes Elavil. The examiner noted that the Veteran experiences headache pain that is constant, localized to one side of the that worsens with physical activity.  

The examiner noted that the Veteran's non-headache symptoms associated with his headaches include nausea, sensitivity to light and sound, lasting less than a day, on the right side of the head.  The examiner further stated that the Veteran has characteristic prostrating attacks less frequently than one in 2 months over the last several months.  The examiner noted that the Veteran does not have very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic adaptability. 

Addressing functional impact, the examiner noted that during migraine attack a few times a year, the Veteran will need to lay down in a dark room during these severe attacks. In an August 2021 rating decision, the RO noted receipt of the July 2020 claim to re-evaluate the prior decision to reduce his headaches and continued the 0
 sensitivity to light and sound, lasting less than a day, on the right side of the head.  The examiner further stated that the Veteran has characteristic prostrating attacks less frequently than one in 2 months over the last several months.  The examiner noted that the Veteran does not have very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic adaptability. 

Addressing functional impact, the examiner noted that during migraine attack a few times a year, the Veteran will need to lay down in a dark room during these severe attacks. In an August 2021 rating decision, the RO noted receipt of the July 2020 claim to re-evaluate the prior decision to reduce his headaches and continued the 0 percent disability rating effective May 10, 2021.

In considering whether a reduction was proper, the Board must focus on the evidence of record available to the AOJ at the time the reduction was effectuated, although post-reduction medical evidence may be considered for the limited purpose of determining whether the condition had demonstrated sustained, actual improvement.  Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992).  

At his May 2025 Board hearing, the Veteran testified that he has roughly six headaches per month. Regarding prostrating headaches, the Veteran testified that he has at least six per month, lasting the entire day, where he has to shut everything off, turn the lights off and take medication. See May 2025, Board Hearing transcript, pgs. 3-4.  At his hearing, the Veteran affirmed that he never had less frequent attacks than one over the last several months. See May 2025, Board Hearing transcript, pgs. 6-8.

The Board notes that on the day of his hearing, the Veteran submitted a letter from his employer that the Veteran's headaches have caused him to miss many days of work over the course of the two and half years he has been with the company. See May 8, 2025, Buddy Lay Statement.

The Veteran also submitted a Headache/Migraine log, spanning the months of February 2025 through April 2025.  The Headache/Migraine log documents the days in each month in which he missed work, had to lay down and spend the day in bed.  The Headache/Migraine log documents the frequency of very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic adaptability for the period from February 4, 2025 - April 17, 2025.  

After careful review of the record, the Board finds that evidence does not show actual improvement in the Veteran's migraine headaches or in his ability to function under the ordinary conditions of life and work.  Stern, 34 Vet. App. 51. 

First, in the August 2021 rating decision, the AOJ did not address whether there was improvement in the Veteran's ability to function under the ordinary conditions of life and work when reducing the rating for the Veteran's migraine headaches. This issue of whether there was improvement in the Veteran's ability to function under the ordinary conditions of life and work was also not addressed in the June 2021 rating decision.

Further, while the May 2021 VA examiner found that the Veteran does not have very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic adaptability, the examiner does not reconcile this finding with the Veteran's report, and the examiner's documentation that the Veteran misses work, 2-3 x's  a month due to incapacitating headaches-and that his headaches associated with poor concentration and focus may impact him in the work place. See May 2021, Headaches examination, pgs. 2-3.

The Board also notes that in the August 2021 records review examination, the examiner noted that the Veteran does not have very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic adaptability, and that during a migraine attack a few times a year, the Veteran will need to lay down in a dark room. The Board observes however that the examiner also does not reconcile this finding with the other evidence of record, including the previous examiner's documentation that he misses work, 2-3 x's a month due to incapacitating headaches-and that his headaches associated with poor concentration and focus may impact him in the workplace. See May 2021, Headaches examination, pgs. 2-3; August 2021, records review examination, pgs. 3-4. The Board observes that neither examiner reconciles this finding with March 2021 medical records documenting, the Veteran's migraines sometimes limit him from going to work and that he continues to get 6 migraines a week on average, along with some tension headaches
 dark room. The Board observes however that the examiner also does not reconcile this finding with the other evidence of record, including the previous examiner's documentation that he misses work, 2-3 x's a month due to incapacitating headaches-and that his headaches associated with poor concentration and focus may impact him in the workplace. See May 2021, Headaches examination, pgs. 2-3; August 2021, records review examination, pgs. 3-4. The Board observes that neither examiner reconciles this finding with March 2021 medical records documenting, the Veteran's migraines sometimes limit him from going to work and that he continues to get 6 migraines a week on average, along with some tension headaches. The Board finds the VA examinations the RO relied on to reduce the Veteran's disability rating from 50 percent to 0 percent disabling prior to the rating decision on appeal, inadequate. See 38 C.F.R. § 4.2.

As the Board finds the VA examination reports are inadequate, the Board further finds that the rating reduction was improper.  Therefore, the Board finds the claim is warranted and the appeal is granted.  Accordingly, the 50 percent rating for migraine headaches is restored effective May 10, 2021.

 

 

Michael A. Pappas

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Little, Calvin

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.