MIGRAINE

Summary

The Veteran, who served from May 1989 to January 1997, appeals the denial of service connection for headaches, claiming they are secondary to his service-connected sleep apnea. The Board first confirmed the Veteran has a current diagnosis of tension headaches, satisfying the first element for secondary service connection. The Board also noted the Veteran is already service-connected for sleep apnea (50%), degenerative disc disease (40%), tinnitus (10%), and GERD (10%), satisfying the second element. The core issue was the nexus between these service-connected conditions and the headaches. The March 2025 VA examination concluded the tension headaches were less likely than not related to or aggravated by sleep apnea, citing multifactorial causes for tension headaches and no direct medical link to sleep apnea. Conversely, the Veteran submitted a private medical opinion from Dr. J.C. in August 2025, which opined that the headaches were more likely than not aggravated by cervical spine disability, sleep apnea, tinnitus, and GERD, citing supporting medical studies. The Board found the medical evidence to be in relative equipoise, with the VA examiner's negative opinion balanced by Dr. J.C.'s positive opinion. Applying the benefit of the doubt, the Board found Dr. J.C.'s opinion to be competent and probative, ultimately concluding that service connection for headaches as secondary to service-connected disabilities is warranted.

Rationale

Current diagnosis of tension headaches established.; Veteran service-connected for sleep apnea.; Medical evidence in relative equipoise regarding nexus.; Benefit of the doubt applied in Veteran's favor.

Full Decision Text

Citation Nr: A26040738
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260122-627409
DATE: April 30, 2026

ORDER

Entitlement to service connection for headaches, to include as secondary to service-connected disabilities, is granted.

FINDING OF FACT

Resolving reasonable doubt in his favor, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran's headaches are secondary to service-connected disabilities.

CONCLUSION OF LAW

The criteria for entitlement to service connection for headaches as secondary to service-connected disabilities have been met. 38 U.S.C. § 1110, 1154, 5107 (2012); 38 C.F.R. § 3.303; 38 C.F.R. § 3.309 (2020).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from May 1989 to January 1997.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the January 2026 VA Form 10182 the Veteran selected the evidence submission lane. Accordingly, the Board will consider the evidence of record submitted within 90 days of the election of the Evidence Submission Lane. See 38 C.F.R. § 3.2400 (c)(2).

Entitlement to service connection for headaches, to include as secondary to service-connected sleep apnea

The Veteran asserts entitlement to service connection for migraines. Specifically, the Veteran contends that his migraines are secondary to his service-connected sleep apnea. See November 2024 Supplemental Claim. 

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. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448.

In order to prevail on the issue of entitlement to secondary service connection, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence, generally medical, establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998).

The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007).

When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail.  See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 

The Veteran was afforded a VA examination in March 2025. The VA examiner noted a current diagnosis of tension headaches. The Veteran reported a symptom onset in 2013. Following the examination, the VA examiner opined that the Veteran's tension headaches are less likely than not due to or the result of his service-connected sleep apnea. In support of this opinion, the VA examiner reasoned that migraines and sleep apnea are not medically related. The VA examiner reported that tension headaches are multifactorial, involving both peripheral and central mechanisms, not related to sleep apnea. The VA examiner did not provide an
 prevail.  See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 

The Veteran was afforded a VA examination in March 2025. The VA examiner noted a current diagnosis of tension headaches. The Veteran reported a symptom onset in 2013. Following the examination, the VA examiner opined that the Veteran's tension headaches are less likely than not due to or the result of his service-connected sleep apnea. In support of this opinion, the VA examiner reasoned that migraines and sleep apnea are not medically related. The VA examiner reported that tension headaches are multifactorial, involving both peripheral and central mechanisms, not related to sleep apnea. The VA examiner did not provide an aggravation opinion. 

The Veteran has submitted an August 2025 private medical opinion, provided by Dr. J.C. The Veteran reported a symptom onset in 2013, coinciding with reduced sleep due to his tinnitus. Dr. J.C. opined that the Veteran's headaches are more likely than not aggravated by his cervical spine disability, sleep apnea, tinnitus, and GERD. In support of this opinion, Dr. J.C. cited to multiple medical studies linking headaches to sleep apnea, cervical spine degenerative disc disease, tinnitus, and GERD. Dr. J.C. linked the Veteran's current symptoms with the cited medical studies. 

The first and most fundamental requirement for any secondary service connection claim is the existence of a current disability. 38 U.S.C. §§ 1110, 1131; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As an initial matter, the Board finds that the Veteran has satisfied the first element of secondary service connection, a current headache diagnosis. The Veteran's March 2025 VA examination revealed a diagnosis of tension headaches. Therefore, the Board finds that the Veteran has satisfied the first prong of secondary service connection, the existence of a current disability. 38 U.S.C. §§ 1110, 1131; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000).

As to evidence of a service-connected disability, the Board notes that the Veteran is currently service connected at 50 percent disabling for sleep apnea, 40 percent disabling for degenerative disc disease, 10 percent disabling for tinnitus, and 10 percent disabling for GERD. Therefore, the Board finds that the Veteran has satisfied the second prong of service connection on a secondary basis, evidence of a service-connected disability. 38 U.S.C. §§ 1110, 1131; Boyer, 210 F.3d at 1353.

Furthermore, turning next to evidence of a causal relationship between the service-connected disability and the current disability, the Board finds the weight of the medical evidence is in relative equipoise.

The March 2025 VA examiner opined that the Veteran's headaches are less likely than not due to his service-connected sleep apnea. Meanwhile, Dr. J.C. stated that the Veteran's headaches are aggravated by his cervical spine disability, GERD, tinnitus, and sleep apnea.

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Based on the foregoing and after resolving all doubt in the Veteran's favor, the Board concludes that the probative medical evidence of record is in relative equipoise regarding a causal relationship between the Veteran's headaches and his service-connected disabilities. Overall, the Board finds Dr. J.C.'s medical opinion to be competent and probative evidence that is at least in equipoise with the negative nexus opinion from the March 2025 VA examiner's opinion.

Therefore, the Board finds that service connection for the Veteran's headaches is warranted.

 

 

Ardie A. Bland

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A.C. Slaughter, Associate Counsel

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.