{"page":"https://casescribe.ai/explorer/secondary/hypertension-secondary-to-back","generated_at":"2026-10-03T18:34:22.097Z","data_as_of":{"decisions":944125,"first_year":2017,"last_year":2026,"latest_decision":"2026-04-30","cfr":"2026-10-01","m21":"2026-09-29"},"about":{"publisher":"CaseScribe AI (VA Law Explorer)","source":"Public Board of Veterans' Appeals decisions (appeals of VA decisions, not VA's first decisions), M21-1 Adjudication Procedures Manual, 38 CFR Parts 3 and 4.","method":"Outcomes are issue-level: each condition the Board decided in a decision counts once. Decision data is extracted by AI and can contain errors. Rates describe past appeals and do not predict any claim.","disclaimer":"For research only. CaseScribe AI is not a law firm and this is not legal advice. Verify figures against the source decisions and regulations.","attribution":"Cite as: VA Law Explorer, CaseScribe AI, with the page URL."},"data":{"claim":"Hypertension secondary to a back condition","secondary_condition":"Hypertension","service_connected_disability":"a back condition","decisions":370,"years":"2017-2026","granted_pct":18.9,"denied_pct":21.6,"remanded_pct":58.1,"granted_on_merits_pct":46.7,"by_year":[{"year":2017,"issues":21,"granted_pct":14.3,"denied_pct":33.3,"remanded_pct":38.1},{"year":2018,"issues":22,"granted_pct":4.5,"denied_pct":27.3,"remanded_pct":63.6},{"year":2019,"issues":29,"granted_pct":6.9,"denied_pct":24.1,"remanded_pct":69},{"year":2020,"issues":44,"granted_pct":6.8,"denied_pct":29.5,"remanded_pct":63.6},{"year":2021,"issues":46,"granted_pct":19.6,"denied_pct":28.3,"remanded_pct":52.2},{"year":2022,"issues":40,"granted_pct":15,"denied_pct":10,"remanded_pct":75},{"year":2023,"issues":44,"granted_pct":36.4,"denied_pct":11.4,"remanded_pct":52.3},{"year":2024,"issues":53,"granted_pct":24.5,"denied_pct":22.6,"remanded_pct":52.8},{"year":2025,"issues":55,"granted_pct":25.5,"denied_pct":16.4,"remanded_pct":58.2}],"benefit_of_doubt_in_grants_pct":77.1,"evidence_on_merits":[{"evidence":"va_exam_unfavorable","decisions_with":310,"granted_pct_with":40.5,"granted_pct_without":89.5},{"evidence":"nexus_positive","decisions_with":89,"granted_pct_with":81.4,"granted_pct_without":24.2},{"evidence":"nexus_negative","decisions_with":279,"granted_pct_with":40.5,"granted_pct_without":67.6},{"evidence":"private_opinion","decisions_with":141,"granted_pct_with":61,"granted_pct_without":29.4},{"evidence":"lay_statement","decisions_with":285,"granted_pct_with":35.3,"granted_pct_without":90.3}],"top_reasons":{"granted":[{"reason":"caused by the service-connected disability","decisions":14},{"reason":"service connection established","decisions":10},{"reason":"current diagnosis established","decisions":8},{"reason":"aggravated by the service-connected disability","decisions":3},{"reason":"obesity as intermediate step","decisions":3},{"reason":"hypertension would not have occurred but for obesity","decisions":2}],"denied":[{"reason":"va examiner: less likely than not related to service","decisions":22},{"reason":"no in-service complaints, treatment or diagnosis","decisions":14},{"reason":"preponderance of the evidence against the claim","decisions":9},{"reason":"service records negative or silent","decisions":7},{"reason":"caused by the service-connected disability","decisions":5},{"reason":"no current diagnosis","decisions":4}]},"recent_examples":{"granted":[{"case_id":"A26040091","year":2026,"judge":"ANTHONY C. SCIRÉ, JR","rationale":"Private medical opinion found hypertension due to or aggravated by service-connected thoracolumbar DDD.; VA opinions using \"proximate cause\" standard were deemed inadequate.; Evidence found in approximate balance; benefit of doubt resolved in Veteran's favor."},{"case_id":"26004006","year":2026,"judge":"T. MAINELLI","rationale":"Temporary aggravation may suffice for secondary service connection.; Evidence of record could be reasonably characterized as in approximate balance.; Resolved reasonable doubt in the Veteran's favor."},{"case_id":"A26028098","year":2026,"judge":"TANYA SMITH","rationale":"New and relevant evidence submitted post-hearing.; Private medical opinion links hypertension to obesity caused by service-connected back disability.; Opinion found probative and based on review of record and examination."}],"denied":[{"case_id":"A26035946","year":2026,"judge":"JOHN J. CROWLEY","rationale":"Hypertension not diagnosed in service or within presumptive period.; No continuity of symptomatology from service.; No evidence of hypertension in service or causal link.; VA examiner found less likely than not that hypertension caused by back disability.; Private nexus opinion lacked reasoned medic… [truncated, 15 chars omitted]"},{"case_id":"A26033748","year":2026,"judge":"RAY BARTO SLABBEKORN, JR.","rationale":"New evidence submitted was not relevant to the claim.; No new and relevant evidence since prior denial.; Weight of evidence against claim; benefit of doubt not applicable."},{"case_id":"26001978","year":2026,"judge":"MATTHEW W. BLACKWELDER","rationale":"No chronic in-service symptoms or continuity; Negative nexus opinions from VA examiners (Oct 2024, Aug 2025); No established pathophysiological link to service-connected conditions or TERA"}]},"how_argued":{"note":"From keyword matches in each issue's AI summary and rationale, not the full decision. Only issues whose text names a medical link are counted under pathways; one issue can name several. A link named in a denial was often the argument the Board rejected.","issues":372,"aggravation_discussed":{"issues":159,"granted_pct":10.7},"causation_only":{"issues":213,"granted_pct":25.4},"issues_naming_a_pathway_pct":46.2,"pathways":[{"pathway":"Weight gain or obesity","issues":115,"granted_pct":28.7,"examples":[{"case_id":"A26020159","year":2026,"outcome":"GRANTED","quote":"(APRN) found hypertension at least as likely as not secondary to service-connected lumbosacral strain with subsequent weight gain."},{"case_id":"A26035946","year":2026,"outcome":"DENIED","quote":"The Board denied this claim, giving greater weight to the May 2020 VA examiner's opinion that it was less likely than not that hypertension was caused by the service-connected back disability, citing risk factors like tobacco use,..."}]},{"pathway":"Chronic pain","issues":38,"granted_pct":47.4,"examples":[{"case_id":"26004006","year":2026,"outcome":"GRANTED","quote":"The Board found that while permanent aggravation was not supported, temporary aggravation of blood pressure due to pain and stress from these conditions, combined with limited service records and an approximate balance of evidence,..."},{"case_id":"A24077260","year":2024,"outcome":"DENIED","quote":"The veteran sought service connection for hypertension, claiming it was secondary to his service-connected lumbosacral strain due to pain and sleep disturbance."}]},{"pathway":"Nerve involvement","issues":32,"granted_pct":37.5,"examples":[{"case_id":"26004006","year":2026,"outcome":"GRANTED","quote":"The Veteran sought service connection for hypertension, claiming it was secondary to his service-connected lumbosacral sprain, cervical strain, bilateral tinnitus, right ear hearing loss, and radiculopathy."},{"case_id":"A24077134","year":2024,"outcome":"DENIED","quote":"Alternatively, he claims it is secondary to his service-connected low back disability with associated peripheral neuropathy, leading to obesity and subsequently hypertension."}]},{"pathway":"Reduced activity or mobility","issues":30,"granted_pct":26.7,"examples":[{"case_id":"A25024422","year":2025,"outcome":"GRANTED","quote":"The veteran claims the back condition led to a sedentary lifestyle and weight gain, contributing to hypertension."},{"case_id":"A25017056","year":2025,"outcome":"DENIED","quote":"Hypertension attributed to sedentary lifestyle and hypercholesteremia."}]},{"pathway":"Medication side effects","issues":11,"granted_pct":27.3,"examples":[{"case_id":"24030807","year":2024,"outcome":"GRANTED","quote":"Service connection for hypertension is granted on a secondary basis, as the Board found the evidence to be in equipoise regarding whether the hypertension was caused or aggravated by the Veteran's service-connected thoracolumbar spine..."},{"case_id":"24009488","year":2024,"outcome":"DENIED","quote":"VA examiner's opinion found less likely than not related to NSAID use"}]}]},"how_va_rates":{"citation":"38 CFR 4.104","diagnostic_code":"7101","name":"Hypertensive vascular disease (hypertension and isolated systolic hypertension)","url":"https://www.ecfr.gov/current/title-38/section-4.104","levels":[{"criteria":"Diastolic pressure predominantly 130 or more","rating":60},{"criteria":"Diastolic pressure predominantly 120 or more","rating":40},{"criteria":"Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more","rating":20},{"criteria":"Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control","rating":10}],"notes":["Note (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.","Note (2): Evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation.","Note (3): Evaluate hypertension separately from hypertensive heart disease and other types of heart disease."]},"requirements":"38 CFR 3.310: a current diagnosis, a service-connected disability, and medical evidence that it caused (3.310(a)) or aggravated (3.310(b)) the condition."}}