SYNCOPE

Summary

The Veteran, an Air Force Veteran who served from September 1994 to November 2006, including service in Southwest Asia, appeals the denial of service connection for syncopal episodes. The Veteran's claim was recharacterized from seizures to syncopal episodes to better reflect the evidence. The Board found that the Veteran has a current disability of recurrent syncopal episodes, which are likely vasovagal syncope, not seizures, based on multiple medical opinions and diagnostic tests. Service treatment records from 1996 noted episodes suggestive of vasovagal etiology, and a 2002 consultation also favored vasovagal syncope. While VA fee-based examinations in 2020 found the episodes were likely vasovagal syncope triggered by vomiting, one examiner noted minor seizures, but ultimately concluded no seizure disorder was present. The Board found the evidence preponderated in favor of syncopal episodes. The Veteran also reported her syncopal episodes occurred in conjunction with her service-connected migraine headaches. Evidence, including a 2006 STR and a 2007 informal Line of Duty Determination, indicated syncope secondary to migraines. A 2019 VA treatment record also noted this link. Resolving all reasonable doubt in the Veteran's favor, the Board found the syncopal episodes proximately due to her service-connected migraine headaches. Service connection for syncopal episodes is granted.

Rationale

Weight of evidence indicates syncopal episodes, not seizures.; Multiple medical opinions and diagnostic tests support vasovagal etiology.; Evidence links syncopal episodes to service-connected migraines.

Full Decision Text

Citation Nr: A26040928
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210524-161537
DATE: April 30, 2026

ORDER

Entitlement to service connection for syncopal episodes, to include as secondary to service-connected migraine headaches is granted.

FINDING OF FACT

The Veteran's syncopal episodes are proximately due to her service-connected migraine headaches.

CONCLUSION OF LAW

The criteria for service connection for syncopal episodes, to include as secondary to service-connected migraine headaches have been met.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the U.S. Air Force from September 1994 to March 1998, August 2001 to May 2003, October 2004 to June 2005, July 2005 to January 2006, and from February 2006 to November 2006.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2021 AMA rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the May 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on November 18, 2024.  A transcript is of record. 

Therefore, the Board may only consider the evidence of record at the time of the January 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or her 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. 

The Veteran's claim for service connection for seizures baby mal has been recharacterized as a claim for syncopal episodes to better reflect the evidence of record.  See Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); Clemons v. Shinseki, 23 Vet. App. 1, 9 (2009).

Entitlement to service connection for syncopal episodes, to include as secondary to service-connected migraine headaches.

The Veteran seeks service connection for episodes of loss of consciousness.  For the reasons that follow, and resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran experiences recurrent syncopal episodes that are secondary to her service-connected migraine headaches.  

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Generally, to establish service connection, there must be competent, credible evidence of 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury.  See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Where there is a chronic disease shown as such in service or within the presumptive period under 38 C.F.R. § 3.307, so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes.  If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity.  38 C.F.R. § 3.303(b).

Service connection may be established for chronic diseases, to include epilepsy, manifesting to a certain degree within a year after service.  38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a).

Service connection may also be warranted for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia Theater of Operations, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, during the Persian Gulf War, or that became manifest to any degree anytime thereafter.  See PACT Act, Pub. L. No 117-168, sec. 
 include epilepsy, manifesting to a certain degree within a year after service.  38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a).

Service connection may also be warranted for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia Theater of Operations, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, during the Persian Gulf War, or that became manifest to any degree anytime thereafter.  See PACT Act, Pub. L. No 117-168, sec. 405(a), (d) (2022); see also 38 U.S.C. § 1117, as amended by Public Law 117-16838; C.F.R. § 3.317(a)(1).

A review of the record confirms that the Veteran served in Southwest Asia.  As such, she is considered a Persian Gulf War veteran.  

In light of the Veteran's served in Southwest Asia, she also is presumed to have in-service toxic exposure, to include burn pits and other toxins (BPOT).  38 U.S.C. §§ 1110, 1119, 1120, 5107; 38 C.F.R. §§ 3.102, 3.303; PACT Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022).

In addition to service connection on a direct basis, service connection may also be granted for a disability that is proximately due to or aggravated by a service-connected disease or injury.  38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995).

Turning to the evidence of record, there is no dispute that the Veteran has experienced recurrent episodes of loss of consciousness.  Although the Veteran's claim was for seizures, the weight of the evidence indicates that the black out episodes the Veteran experiences are not seizures but are rather syncopal episodes, most likely vasovagal syncope.  

In this regard, the Veteran's service treatment records (STRs) show that she initially experienced two episodes of loss of consciousness in service in 1996.  The treating provider noted that the Veteran's episodes were suggestive of a vasovagal etiology and that neither episode was followed by a post-ictal state which would be the most specific indication of a seizure.  

The Veteran underwent a neurological consultation in April 2002 at which time the treating provider also opined that the Veteran's episodes did not sound like seizures and that they were probable vasovagal syncope triggered by vomiting. 

A May 2005 STR noted a provisional diagnosis of syncope. 

April 2006 STRs show that the Veteran underwent extensive testing which was within normal limits and no epileptiform abnormalities were noted.  The Veteran was diagnosed with migraine with syncope. 

A review of the Veteran's VA treatment records show that the Veteran underwent a neurological evaluation in 2019 at which time an EEG and an MRI were performed which were unremarkable.

The Veteran underwent VA fee-based examinations in July 2020 and December 2020 at which time the examiners found that the Veteran did not have a seizure disorder.  In a July 2020 VA fee-based opinion, the examiner opined that there was no objective or diagnostic evidence on exam to support a diagnosis of a seizure disorder and that it is more probable that the Veteran's episodes are vasovagal syncope triggered by vomiting.  

Based on the foregoing, the weight of the evidence indicates that the Veteran's episodes of loss of consciousness are syncopal episodes and not seizures.  Although the December 2020 VA fee-based examiner noted in the examination report that the Veteran has experienced minor seizures, he nonetheless concluded that the Veteran did not have a seizure disorder.  Aside from the December 2020 VA fee-based examination report, there is no other competent evidence that the Veteran has a seizure disorder or that her black out episodes are seizures.  All other treating providers have found that the Veteran's episodes are syncopal episodes, and diagnostic testing, including an MRI and EEG, has not been indicative of a seizure disorder.  As such, the Board finds that the Veteran has a current disability of recurrent syncopal episodes.  The first element of service connection has been met. 

At the November 2024 Board hearing, and throughout the record, the Veteran repeatedly reported experiencing her syncopal episodes in conjunction with her migraine headaches. Although no opinion has been obtained that addresses secondary service connection, the evidence of record establishes that the Veteran's syncopal episodes are due to her service-connected migraine headaches. In this regard,
 the Veteran has a seizure disorder or that her black out episodes are seizures.  All other treating providers have found that the Veteran's episodes are syncopal episodes, and diagnostic testing, including an MRI and EEG, has not been indicative of a seizure disorder.  As such, the Board finds that the Veteran has a current disability of recurrent syncopal episodes.  The first element of service connection has been met. 

At the November 2024 Board hearing, and throughout the record, the Veteran repeatedly reported experiencing her syncopal episodes in conjunction with her migraine headaches. Although no opinion has been obtained that addresses secondary service connection, the evidence of record establishes that the Veteran's syncopal episodes are due to her service-connected migraine headaches. In this regard, as noted above, an April 2006 STR diagnosed the Veteran with migraine with syncope.  An April 2007 Informal Line of Duty Determination notes that the Veteran has syncope secondary to migraines. A November 2019 VA treatment record notes that the Veteran's syncopal episodes are likely due to her migraines.  

In light of the foregoing, and resolving all reasonable doubt in favor of the Veteran, the Board finds that her syncopal episodes are proximately due to her service-connected migraine headaches.  As such, service connection for syncopal episodes is warranted, and the claim is granted. 

 

 

C. CRAWFORD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Mortimer, 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.