MIGRAINE

COLLEEN M. GLASER-ALLEN · 2026 · Case ID: A26040619

GRANTED

Summary

The veteran, who served in the U.S. Navy from January 2006 to January 2008, appeals the denial of an increased rating for his service-connected migraine headaches. The veteran initially received service connection for migraines with a 50 percent rating, but a subsequent VA examination led to a reduced rating of 30 percent. The veteran sought to re-establish the 50 percent rating, arguing his migraines were more severe and impacted his ability to work. The Board reviewed the veteran's testimony, lay statements from a colleague, and VA treatment records. The veteran testified that his migraines, occurring 3-5 times a week and lasting 5-6 hours, caused him to miss work frequently and seek emergency care due to the noisy office environment. A colleague corroborated that the veteran's migraines impacted his ability to remain on-site and caused noticeable fatigue. The Board found the December 2020 VA examination inadequate, as it downplayed the frequency and economic impact of the migraines, failing to consider the veteran's credible testimony and lay statements. The Board resolved doubt in the veteran's favor, finding his migraines were very frequent, completely prostrating, and prolonged, leading to severe economic inadaptability. Consequently, the Board granted the appeal, reinstating the 50 percent disability rating for migraines.

Rationale

Veteran's testimony and lay statements support frequent, prostrating attacks.; Attacks are prolonged and capable of producing severe economic inadaptability.; December 2020 VA exam was inadequate for downplaying frequency and economic impact.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8100

Docket No.

210922-187136

Full Decision Text

Citation Nr: A26040619
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 210922-187136
DATE: April 30, 2026

ORDER

Entitlement to a disability rating of 50 percent for service-connected migraine including migraine variants, is granted, subject to the statues and regulations governing the payment of compensation.

FINDING OF FACT

The Veteran's migraine headaches are productive of very frequent, completely prostrating and prolonged attacks capable of producing severe economic inadaptability.

CONCLUSION OF LAW

The criteria are met for entitlement to a 50 percent disability rating for migraine headaches. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.124a, Diagnostic Code 8100.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from January 2006 to January 2008.

Introduction

Procedural History

By way of procedural history, the Veteran filed a claim for service connection for migraines headaches as secondary to his service-connected posttraumatic stress disorder (PTSD) in November 2018. In a March 2019 rating decision, the local regional office (RO), as the agency of original jurisdiction (AOJ), granted service connection for migraine headaches and assigned a 50 percent disability rating, effective November 16, 2018, the date of the Veteran's claim for benefits.

In October 2019, the RO scheduled a new VA examination and medical opinion to obtain clarification on whether the Veteran's migraine headaches were related to his in-service assault resulting in a traumatic brain injury (TBI). Based on the results of that VA examination, the RO assigned a 50 percent disability rating prior to October 30, 2019, and a 30 percent disability from October 30, 2019, onward.

In November 2020, the Veteran filed a claim for an increased rating, which was denied in a December 2020 rating decision. The Veteran subsequently submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review in January 2021. Following an April 2021 HLR informal conference, the AOJ found that there had been a duty to assist error concerning the claim and returned the claim for further development. See April 2021 HLR Return; April 2021 HLR Decision.

In September 2021, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), indicating that he was appealing the April 2021 HLR decision and selected the hearing docket. 38 C.F.R. § 20.202. In April 2025, he testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the proceeding is of record.

Decision on Appeal

Notably, however, April 2021 HLR decision deferred action on the claim to acquire additional evidence need to substantiate the Veteran's claim, namely, a VA medical examination. The identification of a duty to assist error is not a final decision subject to appellate review. See Shipley v. Shinseki, 24 Vet. App. 458, 462 (2011) (holding that "because there is no "final decision" when the [AOJ] issues a deferred rating decision, there has been no "adjudicative determination" from which an NOD can be filed"). Therefore, this appeal would normally be dismissed because there is no appealable determination with which the Veteran has disagreed.

However, as the September 2021 VA Form 10182 was submitted within a year of the December 2020 rating decision deciding the claim, and a Board hearing was held on the issue, the Board interprets the VA Form 10182 as intending to disagree with the December 2020 rating decision, to the extent that it denied an increased rating for service-connected migraines. Such interpretation is to the Veteran's benefit as it not only appears to be his intent but also permits the Board to proceed with adjudicating the appeal.

Accordingly, the Board may only consider the evidence of record at the time of the RO (AOJ) decision the Veteran has appealed (December 2020), as well as any additional evidence he or his attorney submitted during the April 2025 hearing or within 90 days following it during the permissible "grace period" (so until July 2025). See 38 C.F.R. § 20.302(a).

1. Entitlement to a disability rating of 50 percent for service-connected migraine including migraine variants
an increased rating for service-connected migraines. Such interpretation is to the Veteran's benefit as it not only appears to be his intent but also permits the Board to proceed with adjudicating the appeal.

1. Entitlement to a disability rating of 50 percent for service-connected migraine including migraine variants

Legal Principles

Increased Ratings Generally

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history and that there be emphasis upon the limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.2 requires that medical reports be interpreted in light of the whole recorded history, and that each disability is considered from the point of view of the Veteran working or seeking work.

38 C.F.R. § 4.7 provides that, where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating is to be assigned. All reasonable doubt material to the determination is resolved in the Veteran's favor. 38 U.S.C. § 5107; 38 C.F.R. § 4.3.

In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). But where service connection already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, a Veteran may experience multiple distinct degrees of disability that might result in different levels of compensation. Therefore, separate ratings can be assigned for separate periods of time based on the facts found a practice known as "staged" ratings, irrespective of whether an initial or established rating. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

Migraine Rating Criteria

The Veteran's migraine headaches are currently rated under the schedules of ratings for neurological conditions and convulsive disorders, with a 50 percent disability rating, prior to October 30, 2019, and a 30 percent rating, effective from October 30, 2019, onward. 38 C.F.R. §§ 4.124a, Diagnostic Code 8100.

Under Diagnostic Code 8100, a 30 percent rating is warranted for characteristic prostrating attacks occurring on average once a month over the last several months; and the maximum schedular rating of 50 percent is warranted for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under Diagnostic Code 8100. 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. Additionally, in rating headaches or migraines under Diagnostic Code 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

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 migraine headaches, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary
. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Id. Additionally, in rating headaches or migraines under Diagnostic Code 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

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 migraine headaches, 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 headache attacks that typically produce powerlessness, lack of vitality, or extreme exhaustion. See Johnson, 30 Vet. App. at 253; Fenderson v. West, 12 Vet. App. 119 (1999) (in which the Court quotes Diagnostic Code 8100 verbatim but does not specifically address the matter of what is a prostrating attack).

The United States Court of Appeals for Veterans Claims (Court) noted that the four factors to be considered for a 50 percent rating under Code 8100 are "very frequent," "completely prostrating," "prolonged attacks," and "productive of economic inadaptability." Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). These criteria are successive, meaning each criterion for a higher rating must be met in order to warrant such a rating. Johnson v. Wilkie, 30 Vet. App. 245, 253 (2018).

However, neither the Court nor the rating criteria for a 50 percent rating define these four factors. 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 migraine headache attack must render the veteran entirely powerless and has been defined as "completely lacking in vitality or will" and "powerless to rise." Johnson v. Wilkie, 30 Vet. App. 245 (2018); Fenderson v. West, 12 Vet. App. 119 (1999) (in which the Court quotes Diagnostic Code 8100 verbatim but does not specifically address the matter of what is a prostrating attack). 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).

Last, 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 in order to qualify for a 50 percent rating, as such would undermine the purposes of regulations pertaining to a TDIU. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004), see also 38 C.F.R. § 4.16. The Court discussed the notion that consideration must also be given as to whether the disability was capable of producing severe economic inadaptability, regardless of whether the condition was actually causing such inadaptability. See Pierce, 18 Vet. App. at 446. In this regard, VA conceded that the words "productive of" could be read to mean either "producing" or "capable of producing." Id. at 446-447.

Evidence and Analysis

At the outset, the Board notes that during the pendency of this appeal, the principal medical evidence material to the Veteran's claim for an increased rating for his migraine headaches consists of a December 2020 VA examination report, VA outpatient treatment records, and numerous lay statements from the Veteran and others submitted on his behalf. The remainder of the medical treatment records contain no evidence materially inconsistent with the findings of these documents as they relate to the severity of the Veteran's disability. All these records have been reviewed by the Board, although they will not all be discussed in assessing the rating assigned to the Veteran's migraine headaches. Gonzales v
or "capable of producing." Id. at 446-447.

Evidence and Analysis

The Board finds that a higher, 50 percent disability rating is warranted for the appeal period. In this regard, the medical and lay evidence of record supports that the Veteran had characteristic prostrating attacks occurring once per month, which are prolonged attacks capable of producing severe economic inadaptability.

As pertinent here, the Veteran's own testimony regarding contemporaneous symptoms and limitations can establish prostration if the testimony is credible, and symptoms are otherwise competently attributed to migraine headaches through medical evidence. Jandreau, 492 F.3d at 1377. In this regard, the facts below are particularly significant.

During the April 2025 Board hearing, the Veteran reported that his headaches have remained the same in their severity since earlier VA examinations warranting a higher 50 percent rating. He experiences more than ten headaches per month that manifest in blurry vision, nausea, sensitivity to light and sound, and cognitive fatigue. When his migraines are bad, they last approximately 5 to 6 hours, 3 to 5 times a week. See Headache Log. The Veteran uses gabapentin, naproxen, magnesium, and ibuprofen to treat his migraines.

Notably, the Veteran submitted evidence that his headaches affect his ability to work. See, e.g., April 2025 Board Hearing Transcript. He consistently must push deadlines, reschedule projects and meetings, and has requested reasonable accommodation due to his headaches. See also Request for Medical Documentation. He often must take off work for his headaches, up to several days per month. Within his first week back in the office after a return from remote work, he had to go to emergency room for his headaches due to the noisy in-office work environment.

In support of his claim, he submitted a statement from his colleague, R.C.T., who noted that the Veteran experiences frequent migraines, which at times have impacted his ability to remain on-site for the full duration of a shift. These episodes often cause him to withdraw from work, appearing noticeably less energetic than usual. R.C.T. has observed the Veteran taking breaks, stepping away from an event, or even needing to rest in his car for a few hours during a shift once a migraine begins.

In December 2020, the Veteran was afforded a VA examination to assess his migraines. The examiner noted that he used magnesium to treat his headaches. The Veteran described pulsating or throbbing head pain on both sides of the head that worsened with physical activity. He reported non-headache symptoms including nausea and sensitivity to light and sound. The December 2020 VA examiner documented characteristic prostrating attacks were noted as once a month over the last several months, but not productive of severe economic inadaptability. There were no other physical findings. However, it was also noted that his headaches impacted his ability to work. The examiner explained that the required rest or a day off during a severe headache episode.

The Board finds that the December 2020 examiner disregarded the Veteran's lay statements and medical history in concluding that his migraine attacks were not capable of producing severe economic inadaptability. The Board concludes that the Veteran's hearing testimony and evidence clearly showed greater frequency of characteristic prostrating attacks that caused, or could have caused, the Veteran to miss work, on average, more than once a month. In this regard, the Board finds the December 2020 VA examination inadequate.

However, even if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). If the opinion is merely lacking in detail, then it may be given some weight based upon the amount of information and analysis it contains. Id. Therefore, the Board assigns the December 2020 opinion probative value, limited only by the foregoing inadequacy. In this
have caused, the Veteran to miss work, on average, more than once a month. In this regard, the Board finds the December 2020 VA examination inadequate.

However, even if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). If the opinion is merely lacking in detail, then it may be given some weight based upon the amount of information and analysis it contains. Id. Therefore, the Board assigns the December 2020 opinion probative value, limited only by the foregoing inadequacy. In this regard, the Board finds that the Veteran's lay statements and those submitted on his behalf tend to supplement, rather than contradict, the otherwise competent, credible, and probative medical evidence.

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Therefore, the Board resolves doubt in the Veteran's favor and finds his migraines manifest in very frequent, completely prostrating, and prolonged attacks capable of producing severe economic inadaptability. As such findings correspond to the criteria for a 50 percent rating under Diagnostic Code 8100, the Board finds a 50 percent rating is warranted for the Veteran's migraine symptoms. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990) ("a [V]eteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail"); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) ("When the evidence is in approximate balance in the Veteran's favor or nearly equal regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant").

Accordingly, the appeal is granted.

Colleen M. Glaser-Allen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mukherjee, Cameron B.

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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