GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Summary

The Veteran, a Veteran who served from January 2003 to July 2007, appeals the denial of an increased disability rating for migraines. The Board previously granted service connection for migraines at 30 percent in April 2025, but the Veteran sought a higher rating. The current appeal focuses on whether the Veteran's migraines meet the criteria for a 50 percent disability rating, which requires "very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability." The Veteran's lay statements and VA examination reports describe migraines occurring one to three times per week, lasting several hours, and requiring him to avoid light and screens, modify his work environment, and occasionally leave work early or call off entirely. While VA examiners noted the migraines were not "completely prostrating" or productive of "severe economic inadaptability," the Board found the Veteran's lay statements, detailing the need to shut off lights, avoid screens, have colleagues cover his class, lay his head down, leave work early, and call off work, demonstrated "severe economic inadaptability." The Board also noted the Veteran's statement that medication provided limited relief. Applying the benefit of the doubt, the Board concluded that the Veteran's migraines warranted a 50 percent disability rating.

Rationale

Harmonizes with the October 2022 VA examiner's description of prostrating attacks and functional impact.; Considers Veteran's lay statements detailing severe economic inadaptability, including needing to avoid screens, modify work, leave early, or call off work.; Resolves all reasonable doubt in the Veteran's favor.

Full Decision Text

Citation Nr: A26040915
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 240725-458240
DATE: April 30, 2026

ORDER

Entitlement to a 50 percent disability rating for migraines is granted.

FINDING OF FACT

Throughout the appeal period, the Veteran's migraine headaches caused characteristic very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

CONCLUSION OF LAW

The criteria for a 50 percent disability rating for migraines have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8100.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 2003 to July 2007. 

In July 2024, the Board of Veterans' Appeals (Board) received a VA Form 10182, Decision Review Request: Board Appeal electing the Direct Review docket to review a June 2024 higher-level review rating decision issued by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). Therefore, the Board may only consider the evidence of record at the time of the February 2024 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

This matter has previously been before the Board, which, in an April 2025 Decision, granted a 30 percent evaluation, but no higher, for migraines. The Veteran appealed to the Court of Appeals for Veterans Claims (Court). In a December 2025 Joint Motion for Partial Remand (JMPR), the Court vacated the Board's April 2025 Decision to the extent that it denied entitlement to a rating in excess of 30 percent for migraines and to address whether evidence showing that the Veteran had to  (1) shut the lights off, (2) avoid screens, (3) have another teacher look over his class while he moved to a quiet environment, (4) lay his head down on his desk, (5) leave work early, and (6) call off of work entirely due to his migraines demonstrated his headaches were capable of producing severe economic inadaptability; and remanded the matter, for action consistent with the terms of the JMPR. See December 2025 CAVC Decision. The matter is now again before the Board for consideration.

1. Entitlement to a 50 percent disability rating for migraines

The Veteran, through his attorney, contends that he is entitled to a 50 percent disability rating for his migraines. See February 2026 Appellate Brief. 

Increased Ratings

The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. According to the United States Court of Appeals for the Federal Circuit in Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021), the proper standard of review is whether the factors are in an "approximate balance." Lynch held that the Veteran is entitled to the benefit of the doubt when the evidence is in an approximate balance, i.e., nearly equal and does not require the evidence to be in exact equipoise. Id.

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to
 under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

In this case, the Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). He is also competent to report symptoms of his migraines. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe his symptoms and their effects on employment or daily activities.

The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1. Where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008). 

The Board notes that migraine headaches are rated pursuant to the criteria for General Rating Formula. See 38 C.F.R. § 4.124a, DC 8100. 

Under 38 C.F.R. § 4.124a, DC 8100: a noncompensable rating is assigned for less frequent attacks. A 10 percent rating is assigned where headaches present with characteristic prostrating attacks averaging one in 2 months over last several months. A 30 percent rating is assigned where headaches present with characteristic prostrating attacks occurring on an average once a month over last several months. A 50 percent rating is assigned where headaches present with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

The Court has held that Diagnostic Code 8100 contains successive and conjunctive rating criteria, so all criteria of the lower level must be satisfied, in addition to the criteria for the next higher level, to warrant the higher rating. Johnson v. Wilkie, 30 Vet. App. 245 (2018).

Notably, "the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria." Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). As Diagnostic Code 8100 does not contemplate the effects of medication in alleviating the frequency and duration of the Veteran's headaches, the Board is precluded from considering the relief afforded by the Veteran's medication, if any, in evaluating the severity of his disability and has not done so herein.

Neither VA nor the Court has defined the terms used in Diagnostic Code 8100. Concerning the 50 percent criteria, the Court previously found that "productive of severe economic inadaptability" means that the headaches "produce or [are] capable of producing" severe economic inadaptability. Concerning "inadaptability," the Court found that "nothing in DC 8100 requires that the claimant be completely unable to work" for the 50 percent rating level. Pierce v. Principi, 18 Vet. App. 440, 444-46 (2004).

In Johnson, the Court found that a 50 percent rating requires all of the following criteria: "very frequent" headaches, that are "completely" prostrating, with
 has defined the terms used in Diagnostic Code 8100. Concerning the 50 percent criteria, the Court previously found that "productive of severe economic inadaptability" means that the headaches "produce or [are] capable of producing" severe economic inadaptability. Concerning "inadaptability," the Court found that "nothing in DC 8100 requires that the claimant be completely unable to work" for the 50 percent rating level. Pierce v. Principi, 18 Vet. App. 440, 444-46 (2004).

In Johnson, the Court found that a 50 percent rating requires all of the following criteria: "very frequent" headaches, that are "completely" prostrating, with "prolonged" attacks, that are "productive of severe economic inadaptability." 30 Vet. App. at 252-53. The Court further found that "completely" prostrating subsumes the lower level of "characteristically" prostrating attacks in the 10 and 30 percent ratings, and the higher frequency requirement of "very frequent" necessarily means greater than once a month as in the 30 percent level. Id.

In Johnson, the Court declined to adopt definitions but pointed to non-medical dictionary definitions from Webster's Third New International Dictionary of The English Language Unabridged (1966). The Court noted that "characteristic" was defined as "a trait, quality, or property or a group of them distinguishing an individual, group, or type"; and "prostrating" was defined as "lacking in vitality or will: powerless to rise: laid low." Id. at 252. The term "completely" is defined as "to complete degree: entirely" and, therefore, "completely prostrating" under Diagnostic Code 8100 must render the Veteran "entirely powerless." Id. at 253. Finally, "prolong" is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id.

Similar to these non-medical definitions, the Board observes that a medical dictionary defines prostration as "extreme exhaustion or powerlessness." Dorland's Illustrated Medical Dictionary 1554 (31st ed. 2007). The medical dictionary also defines migraines as "an often familial symptom complex of periodic attacks of vascular headache, usually temporal and unilateral in onset, commonly associated with irritability, nausea, vomiting, constipation or diarrhea, and often photophobia." Id. at 1183. Some types of migraine may involve visual disturbances or blurring, vertigo or dizziness, and incoordination. Id. at 1183-84. Thus, a characteristic migraine attack may include these types of symptoms.

In general, where there is a question as to which of two evaluations shall be applied, a higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7. However, this rule does not apply to ratings for certain disabilities, including migraines or analogous headaches evaluated under DC 8100.  Johnson, 30 Vet. App. at 252. The rating criteria in DC 8100 are successive, meaning that criteria for the lower rating must be met before a higher disability rating may be awarded. Id. at 247, 251-54. Because the criteria are successive, 38 C.F.R. § 4.7 is inapplicable, meaning that a higher rating cannot be granted based on a finding that the Veteran's disability picture more nearly approximates the criteria for the next higher rating. Id. at 253-54. However, any reasonable doubt regarding the degree of the disability will be resolved in favor of the Veteran. Id. at 254; 38 C.F.R. § 4.3.

Factual Background and Analysis

In August 2020, the Veteran noted that he experienced migraines one to three times per week. See August 2020 VA Form 21-526EZ at 15.

During a May 2021 VA examination, the Veteran reported that his migraines had gotten worse. See July 2021 C&P Exam at 3. He reported that he experienced migraine attacks once per week, which requires him to turn lights off and he reported taking over-the-counter Tylenol three times per week and having caffeine daily to try to treat his migraines. Id. The examiner noted that the Veteran experienced headache pain on both sides of the head. Id. at 4. Additionally, the examiner noted that the Veteran had the following non-headache related symptoms: sensitivity to light, changes in vision (such as scotoma, flashes of light, tunnel vision), and changes in mood. Id. at 5. The examiner noted that
 2021 VA examination, the Veteran reported that his migraines had gotten worse. See July 2021 C&P Exam at 3. He reported that he experienced migraine attacks once per week, which requires him to turn lights off and he reported taking over-the-counter Tylenol three times per week and having caffeine daily to try to treat his migraines. Id. The examiner noted that the Veteran experienced headache pain on both sides of the head. Id. at 4. Additionally, the examiner noted that the Veteran had the following non-headache related symptoms: sensitivity to light, changes in vision (such as scotoma, flashes of light, tunnel vision), and changes in mood. Id. at 5. The examiner noted that the pain typically lasted approximately one to two hours. Id. The examiner noted that the Veteran did not experience prostrating attacks of headache pain, very prostrating or prolonged attacks productive of severe economic inadaptability, or functional impact as a result of his migraines. Id. at 6-7.

In the November 2021 higher-level review informal conference, the Veteran stated that he gets migraines at least once per week (sometimes more), which require him to turn off all the lights and put his head down. See November 2021 HLR - Informal Conference at 1. Additionally, the Veteran noted that if he is home he lays down and sometimes, he has to return to is home if he experiences a severe migraine. Id. 

On the March 2022 Supplemental Claim application, the Veteran reported that he was requesting an increased rating due to frequent prostrating migraines that occur weekly and last several days. See March 2022 VA Form 20-0995 at 3.

During the October 2022 VA examination, the Veteran described his headaches as affecting both sides of the head, associated with light sensitivity, visual and mood changes, typically lasting less than one day. See October 2022 C&P Exam at 3. The examiner noted that the Veteran takes Tylenol (1000mg) for his migraines and noted the following symptoms: pain on both sides of the head; sensitivity to light; changes in vision (such as scotoma, flashes of light, tunnel vision); and mood changes. Id. Additionally, the examiner noted that the Veteran's headaches typically lasted less than 1 day, caused pain on both sides of the head, and caused prostrating attacks with less frequent attacks which were not productive of severe economic inadaptability. Id. at 4. The examiner noted that there were no other pertinent findings and the condition caused functional impact as the Veteran "must remain in a dark environment during severe migraine headache flares and he is unable to perform all activities during this time." Id. at 4-5.

In October 2023 the Veteran submitted a lay statement regarding his migraine symptoms. The Veteran reported that he had experienced about three to four headaches per week, lasting about four to eight hours. See October 2023 Correspondence. The Veteran added that the pain typically occurred between the eyebrows or temples. Id. He reported that he experienced frequent migraines, which can last from eight hours to three days, are triggered or aggravated by bright lights, loud noises, and his service-connected tinnitus. Id. Additionally, the Veteran reported that he experienced throbbing and pulsating head pain during a migraine, which worsened with physical activity and caused him to lay down in a dark room. Id. The Veteran reported that sometimes he was unable to concentrate to drive during his migraines and on occasion, his wife has to pick him up from work due to his migraine symptoms. Id. The Veteran noted that he is employed as a teacher and sometimes had to avoid computer screens, modify lighting, and put on videos for his students during his migraines. Id. At work, the Veteran noted that he has received permission to leave the classroom about once or twice a week during when he experiences migraines. Id. The Veteran stated that he has to call off work when he wakes up with a migraine. Id. Additionally, the Veteran noted that he drinks caffeine and takes Tylenol to help with the migraine pain, although they do not completely rid him of the pain. Id. Lastly, the Veteran noted that he had "lightheadedness during headaches and dizziness during migraines" and has experienced nausea and every couple of months has vomited due to his migraines. Id. 

During a November 2023 VA examination, the Veteran described his current symptoms as pulsating head pain, sensitivity to light/sound, and blurred vision. See November C&P Exam at 2. The Veteran reported that he treats his migraines with Tylenol and caffeine. Id. The examiner noted that the Veteran experienced pain on both sides of the head, which typically lasts less than one day; nausea; sensitivity to light
 to help with the migraine pain, although they do not completely rid him of the pain. Id. Lastly, the Veteran noted that he had "lightheadedness during headaches and dizziness during migraines" and has experienced nausea and every couple of months has vomited due to his migraines. Id. 

During a November 2023 VA examination, the Veteran described his current symptoms as pulsating head pain, sensitivity to light/sound, and blurred vision. See November C&P Exam at 2. The Veteran reported that he treats his migraines with Tylenol and caffeine. Id. The examiner noted that the Veteran experienced pain on both sides of the head, which typically lasts less than one day; nausea; sensitivity to light; sensitivity to sound; and changes in vision (such as scotoma, flashes of light, tunnel vision). Id. at 2-3. Further, the examiner noted that the Veteran did not experience prostrating attacks, completely prostrating attacks and prolonged attacks, or functional impact as a result of his migraines. Id. at 4-5.

The Veteran contends that he is entitled to a 50 percent disability rating for the entire period on appeal. See generally July 2024 VA Form 10182; February 2026 Apellate Brief. 

The September 2021 AOJ rating decision granted service connection for the Veteran's migraines and assigned a noncompensable rating, effective August 23, 2020, under Diagnostic Code (DC) 8100. See generally 38 C.F.R. § 4.124a, DC 8100

The June 2024 higher-level review rating decision assigned a 10 percent rating for the Veteran's service-connected migraines effective November 14, 2023, under DC 8100. Id.  

As noted above, the Board previously granted a 30 percent rating for the entire period on appeal, under DC 8100. Id. 

As an initial matter, the Board finds that these examinations are adequate for adjudication purposes and affords them great probative value. See Nieves-Rodriguez, 22 Vet. App. At 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion."). As discussed below, the Board has afforded the Veteran the benefit of doubt. 

Additionally, the Board is cognizant of the fact that the Veteran has used medication, including Tylenol, to treat his migraine pain. Diagnostic Code 8100 does not specifically contemplate the ameliorative effects of medication. The Board acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," unless such effects are otherwise contemplated in a particular diagnostic code.  Ingram v. Collins, 38 Vet. App. 130, 132 (2025). The Board notes, however, that Ingram does not address how the Board is to discount the beneficial effects of medication, particularly when used as treatment for migraine symptoms and where examiners do not reasonably have the ability to assess severity with and without use of medication. 

Moreover, in this case, the respective VA examiners and private examiner, in rendering findings on the severity, frequency, and duration of headaches, noted and considered the Veteran's lay statements describing functional limitations when his pain and functional impairment is at its worst (e.g., with noise sensitivity, visual disturbances, throbbing pain, dizziness, etc.). The examination reports in their entirety do not indicate whether the Veteran was on any pain medications at the time of the examinations, but in any case, it is clear the examiners already provided opinions that discounted any potential ameliorating effects of medication. As such, the Board finds the reports and the remainder of the evidentiary record adequate to base a decision, resolving all reasonable doubt in the Veteran's favor.

Furthermore, the Board notes that the Veteran stated that the Tylenol does not completely rid him of the migraine pain. See October 2023 Correspondence. Accordingly, it is clear that medication had limited effect.

Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran's favor, the Board concludes that a 50 percent disability rating is warranted.

As noted above, in order to be entitled to a rating exceeding 30 percent, the evidence must show that the Veteran has headaches of very frequent, completely prostrating intensity, and prolonged attacks productive of (or capable of producing) severe economic inadaptability. 38 C.F.R. § 4.124(a), DC 8100. 

The Board observes that the record did not demonstrate that the Veteran required bed rest to treat his headaches. However, the October 2022 VA examiner described the Veteran's migraines as prostrating in nature. While the October 2022 examiner
 this case, and with resolution of all reasonable doubt in the Veteran's favor, the Board concludes that a 50 percent disability rating is warranted.

As noted above, in order to be entitled to a rating exceeding 30 percent, the evidence must show that the Veteran has headaches of very frequent, completely prostrating intensity, and prolonged attacks productive of (or capable of producing) severe economic inadaptability. 38 C.F.R. § 4.124(a), DC 8100. 

The Board observes that the record did not demonstrate that the Veteran required bed rest to treat his headaches. However, the October 2022 VA examiner described the Veteran's migraines as prostrating in nature. While the October 2022 examiner noted that the Veteran had less frequent attacks of migraine pain and the May 2021 and November 2023 VA examiners did not describe the Veteran's migraines as prostrating in nature, the Board has also considered the Veteran's lay reports of his symptoms. Specifically, as noted above, the Veteran reported migraines that occur about three to four times per week and last for several hours (up to several days) with symptoms such as  pain on both sides of the head, which is worse with physical activity; nausea; sensitivity to light; sensitivity to sound; changes in vision; dizziness; etc. 

Accordingly, the evidence of record supports a finding that he has very frequent and prolonged prostrating migraines. 

The Board also concludes that the evidence of record likely demonstrates that the severity of the Veteran's headache disability is productive (or capable of producing) severe economic inadaptability.

Notably, the October 2022 VA examiner noted that the Veteran's migraines impacted his ability to work as the Veteran  "must remain in a dark environment during severe migraine headache flares and he is unable to perform all activities during this time." Further, the record contains statements from the Veteran explaining that when he experiences a migraine attack at work, he has to shut the lights off, avoid screens, have another teacher look over his class while he moves to a quiet environment, lay his head down on his desk, leave work early, and sometimes has to call off of work entirely due to his migraines. 

Based on the foregoing, the evidence shows that the Veteran has very frequent completely prostrating and prolonged migraine attacks that are capable of producing severe economic inadaptability. Consequently, the Board finds that the Veteran's headache disability warrants a 50 percent disability rating.

The Board has also considered and finds that no other diagnostic codes are applicable such that a higher or separate rating is warranted. While the Veteran did report dizziness/lightheadedness from his headaches, such a symptom does not warrant a separate rating. The VA rating criteria do not rate dizziness as an independently compensable symptom absent objective findings of a vestibular disorder. See 38 C.F.R. § 4.87, Diagnostic Code 6204. As there has been no such finding in the Veteran's case, nor is there any indication that headaches have caused a vestibular disorder, a separate rating is not warranted.

Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran's migraine disability warrants a 50 percent disability rating.

 

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Lewis, Aliece M.

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.