{"page":"https://casescribe.ai/explorer/secondary/hypertension-secondary-to-ptsd","generated_at":"2026-10-03T18:34:24.497Z","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 PTSD","secondary_condition":"Hypertension","service_connected_disability":"PTSD","decisions":3194,"years":"2017-2026","granted_pct":16.5,"denied_pct":19.8,"remanded_pct":61.6,"granted_on_merits_pct":45.4,"by_year":[{"year":2017,"issues":316,"granted_pct":12.3,"denied_pct":33.2,"remanded_pct":48.4},{"year":2018,"issues":384,"granted_pct":14.1,"denied_pct":24.2,"remanded_pct":57},{"year":2019,"issues":406,"granted_pct":15.3,"denied_pct":16.7,"remanded_pct":66.3},{"year":2020,"issues":446,"granted_pct":11.2,"denied_pct":23.5,"remanded_pct":63.2},{"year":2021,"issues":442,"granted_pct":11.1,"denied_pct":23.8,"remanded_pct":64.7},{"year":2022,"issues":342,"granted_pct":18.4,"denied_pct":12,"remanded_pct":68.1},{"year":2023,"issues":274,"granted_pct":23,"denied_pct":14.2,"remanded_pct":62},{"year":2024,"issues":269,"granted_pct":21.6,"denied_pct":14.9,"remanded_pct":63.6},{"year":2025,"issues":234,"granted_pct":26.5,"denied_pct":12,"remanded_pct":60.3},{"year":2026,"issues":97,"granted_pct":33,"denied_pct":12.4,"remanded_pct":53.6}],"benefit_of_doubt_in_grants_pct":79.7,"evidence_on_merits":[{"evidence":"va_exam_favorable","decisions_with":359,"granted_pct_with":76.6,"granted_pct_without":37.7},{"evidence":"va_exam_unfavorable","decisions_with":2512,"granted_pct_with":42.6,"granted_pct_without":66},{"evidence":"nexus_positive","decisions_with":653,"granted_pct_with":86.6,"granted_pct_without":20.5},{"evidence":"nexus_negative","decisions_with":2102,"granted_pct_with":40.7,"granted_pct_without":62.3},{"evidence":"private_opinion","decisions_with":985,"granted_pct_with":64,"granted_pct_without":30.9},{"evidence":"treating_physician","decisions_with":198,"granted_pct_with":68,"granted_pct_without":43.4},{"evidence":"lay_statement","decisions_with":2264,"granted_pct_with":37.6,"granted_pct_without":75.9},{"evidence":"buddy_statement","decisions_with":76,"granted_pct_with":33.3,"granted_pct_without":45.8},{"evidence":"combat_service","decisions_with":368,"granted_pct_with":42.9,"granted_pct_without":45.8}],"top_reasons":{"granted":[{"reason":"current diagnosis established","decisions":69},{"reason":"service connection established","decisions":49},{"reason":"caused by the service-connected disability","decisions":38},{"reason":"aggravated by the service-connected disability","decisions":29},{"reason":"secondary to ptsd","decisions":10},{"reason":"va examiner: less likely than not related to service","decisions":9}],"denied":[{"reason":"va examiner: less likely than not related to service","decisions":164},{"reason":"no in-service complaints, treatment or diagnosis","decisions":113},{"reason":"preponderance of the evidence against the claim","decisions":68},{"reason":"service records negative or silent","decisions":60},{"reason":"no current diagnosis","decisions":31},{"reason":"no continuity of symptomatology","decisions":24}]},"recent_examples":{"granted":[{"case_id":"A26040725","year":2026,"judge":"M. SORISIO","rationale":"Secondary service connection granted; Substantial weight to private opinion; PTSD impacts heart and vascular function"},{"case_id":"A26040429","year":2026,"judge":"RAY BARTO SLABBEKORN, JR.","rationale":"Current diagnosis of hypertension established.; Obesity identified as intermediate step between MST/PTSD and hypertension.; Evidence supports obesity caused by MST and PTSD."},{"case_id":"A26040417","year":2026,"judge":"BETHANY L. BUCK","rationale":"Private medical opinion found hypertension at least as likely as not secondary to PTSD.; Medical literature supports connection between PTSD and hypertension.; Presumption of soundness applies as hypertension did not clearly pre-exist service."}],"denied":[{"case_id":"A26037126","year":2026,"judge":"L. HOWELL","rationale":"No evidence of in-service incurrence; Private opinion lacked probative value (speculative, correlational); No presumptive service connection (late onset)"},{"case_id":"A26032181","year":2026,"judge":"B.T. KNOPE","rationale":"No in-service symptoms or diagnosis of hypertension; First post-service treatment over 20 years after separation; VA examiner opinion found hypertension not related to PTSD"},{"case_id":"A26026787","year":2026,"judge":"B.T. KNOPE","rationale":"No in-service onset or treatment; VA exams found less likely than not related to toxic exposure; Private opinion lacked specific nexus to veteran's facts; No nexus to PTSD established"}]},"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":3210,"aggravation_discussed":{"issues":1476,"granted_pct":12.5},"causation_only":{"issues":1734,"granted_pct":20.1},"issues_naming_a_pathway_pct":13.9,"pathways":[{"pathway":"Weight gain or obesity","issues":244,"granted_pct":16.8,"examples":[{"case_id":"A26023051","year":2026,"outcome":"GRANTED","quote":"Private and VA opinions acknowledged obesity as a factor in hypertension."},{"case_id":"A26000274","year":2026,"outcome":"DENIED","quote":"The VA examiner cited risk factors like age, obesity, and tobacco use as more likely contributors."}]},{"pathway":"Stress","issues":147,"granted_pct":23.8,"examples":[{"case_id":"A26001058","year":2026,"outcome":"GRANTED","quote":"VA opinion found no nexus between stress and long-term hypertension"},{"case_id":"A26005136","year":2026,"outcome":"DENIED","quote":"Objective testing (EKG, stress test, echocardiogram) normal."}]},{"pathway":"Sleep disruption","issues":23,"granted_pct":30.4,"examples":[{"case_id":"25004992","year":2025,"outcome":"GRANTED","quote":"Medical treatises cited linking PTSD/sleep impairment to hypertension."},{"case_id":"A25063307","year":2025,"outcome":"DENIED","quote":"The veteran appeals the denial of an initial compensable disability rating for hypertension, which is service-connected on a noncompensable basis and considered secondary to PTSD with insomnia disorder."}]},{"pathway":"Chronic pain","issues":16,"granted_pct":31.3,"examples":[{"case_id":"A26032942","year":2026,"outcome":"GRANTED","quote":"Private physician provided nexus opinion linking hypertension to PTSD and chronic pain."},{"case_id":"23003290","year":2023,"outcome":"DENIED","quote":"Private opinion lacked rationale for nexus to chronic pain."}]},{"pathway":"Reduced activity or mobility","issues":14,"granted_pct":21.4,"examples":[{"case_id":"A25072783","year":2025,"outcome":"GRANTED","quote":"The veteran's service treatment records were negative for hypertension, but a private medical opinion linked it to PTSD, citing the veteran's coping mechanisms and inactivity."},{"case_id":"22013735","year":2022,"outcome":"DENIED","quote":"Examiners cited genetics, family history, age, obesity, and inactivity as primary risk factors."}]},{"pathway":"Medication side effects","issues":13,"granted_pct":30.8,"examples":[{"case_id":"A25062964","year":2025,"outcome":"GRANTED","quote":"Private medical opinion found hypertension more likely than not related to PTSD and NSAID use."},{"case_id":"1727932","year":2017,"outcome":"DENIED","quote":"The veteran sought service connection for hypertension, claiming it was secondary to his service-connected PTSD, migraine headaches, seborrheic dermatitis, and erectile dysfunction, or due to medication for these conditions."}]},{"pathway":"Nerve involvement","issues":13,"granted_pct":7.7,"examples":[{"case_id":"21060930","year":2021,"outcome":"GRANTED","quote":"PTSD affects nerve activity and blood pressure regulation."},{"case_id":"21047437","year":2021,"outcome":"DENIED","quote":"Medical literature does not support nexus between hypertension and PTSD, TBI, cervical strain, radiculopathy, ED, or DJD.."}]}]},"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."}}