Citation Nr: 21072290 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 20-14 135 DATE: December 2, 2021 ORDER Entitlement to service connection for migraines secondary to the Veteran's service-connected posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The probative and competent evidence of record shows that the Veteran's migraines were aggravated by his service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for migraines secondary to the Veteran's service-connected PTSD have been met. See 38 U.S.C. §§ 501, 1110, 1111; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1996 to August 1997, October 1998 to February 1999, June 2010 to August 2010, and September 2011 to January 2012. This matter came before the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Board, in pertinent part, denied the claim of service connection for migraines. Thereafter, the Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). The Court granted the parties Joint Motion for Partial Remand (JMPR) that moved to vacate the denial of entitlement to service connection for migraines as the Board failed to provide adequate statements of reasons or bases as to whether the March 2020 medical articles the Veteran submitted were relevant. In May 2021, the Board remanded this matter for a VA examination and medical opinion. SERVICE CONNECTION The Veteran contends that she has a migraine disability which is related to her claimed service-connected psychiatric disability. Service connection may be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310(a). Aggravation of a non-service-connected disease or injury by a service-connected disability may also be service-connected. See 38 C.F.R. § 3.310 (b). Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. The Veteran has a diagnosis of migraines. See September 2021 VAX. Service connection is in effect for PTSD, rated 30 percent disabling, effective February 13, 2018. See April 2021 Codesheet. Therefore, the first and second element of secondary service connection are met. Regarding the third element of secondary service connection, in September 2021 a positive nexus opinion was provided. The VA examiner found that the Veteran's headache condition to include migraines was at least as likely as not aggravated beyond its natural progression by the Veteran's PTSD as the presence of PTSD increases the disability substantially. The examiner cited to medical research in finding that the mechanism contributing to the PTSD and migraine association includes dysfunction of the autonomic nervous system and the hypothalamic pituitary adrenal axis. Supportive of the presence of sympathetic dysfunction, serotonin and norepinephrine levels have been demonstrated to be lower in both those with PTSD and those with migraine. The Board finds that this medical opinion has significant probative value, because the opinion was based on an accurate review of the evidence of record and adequate rationale was provided. Based on the forgoing, the probative evidence weighs in favor of finding a nexus. As the elements of secondary service connection are met, service connection for migraines is granted. M.W. Kreindler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Smith, 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.