HYPERTENSION
THOMAS L. ENGLISH · 2026 · Case ID: 26002222
Summary
The veteran, an Air Force veteran who served from September 1993 to January 1998, appeals the denial of service connection for hypertension. The case was previously before the Board, which denied the claim in May 2024. However, the Court of Appeals for Veterans Claims (CAVC) granted a Joint Motion for Partial Remand (JMPR) due to the Board's failure to address critical medical evidence. Specifically, the CAVC noted a November 2017 private provider letter linking hypertension to service-connected disabilities (psychiatric and back conditions) was not discussed in the VA opinions relied upon by the Board. The Court also found the Board erred by not ensuring VA examiners considered the veteran's lay testimony regarding his rising blood pressure correlating with his back pain. The CAVC also highlighted a reasonably raised theory that anxiety may have caused or aggravated the hypertension. The Board reviewed the evidence, including the November 2017 private letter, a January 2024 VA examiner's notation suggesting a link between psychiatric conditions and hypertension, and a December 2025 VA nexus opinion. This latter opinion found that chronic pain can worsen hypertension by activating the sympathetic nervous system and affecting stress hormones, and that while temporary anxiety might not cause permanent hypertension, chronic anxiety can worsen blood pressure control. The Board found the December 2025 opinion probative and, considering all the evidence, granted service connection for hypertension as secondary to the veteran's service-connected psychiatric and back conditions.
Rationale
Hypertension is secondary to psychiatric and back conditions.; November 2017 private provider letter linked back pain and anxiety to hypertension.; January 2024 VA examiner noted sympathetic nervous system activation from anxiety can raise blood pressure.; December 2025 VA examiner found chronic pain can worsen hypertension via sympathetic nervous system activation and sleep issues.
Full Decision Text
Citation Nr: 26002222 Decision Date: 02/18/26 Archive Date: 02/18/26 DOCKET NO. 19-36 318 DATE: February 18, 2026 ORDER Service connection for hypertension is granted. FINDING OF FACT The Veteran's hypertension is secondary to his service-connected psychiatric condition and his service-connected back condition. CONCLUSION OF LAW The criteria for service connection for hypertension, as secondary to the service-connected psychiatric and back conditions, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Air Force from September 1993 to January 1998. This case comes before the Board of Veterans' Appeals (Board) on appeal of a January 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). By way of history, service connection for hypertension was denied in a May 2024 Board decision. The Veteran appealed to the Court, and in a May 2025 decision, the Court granted a Joint Motion for Partial Remand (JMPR) with respect to this denial. In particular, the JMPR found fault in the Board's failure to address medical evidence. The Court observed the November 2017 private provider letter connecting the Veteran's hypertension to his service-connected disabilities was not discussed in the VA medical opinions relied on by the May 2024 Board decision. The Court concluded the Board erred in finding these medical opinions adequate without discussion of that letter, which weighs in favor of secondary service connection. Second, the Court found the medical examiners failed to consider the Veteran's lay testimony that his blood pressure has risen over the years and believes it roughly corresponds to the ever-increasing levels of severity of his back pain. See April 2018 NOD. The Court found the Board failed to ensure substantial compliance with its August 2023 remand directive to consider the Veteran's lay evidence when it relied on VA opinions that did not review or discuss the Veteran's specific lay statements. Finally, the Court espoused the record raises a reasonable theory that the Veteran's hypertension may be caused or aggravated by his service-connected anxiety disorder. The Court noted anxiety was mentioned in the 2017 private provider letter and was likewise hinted at in a January 2024 VA medical opinion rationales. The Court found the Board's failure to address this reasonably raised theory of entitlement renders its statement of reasons or bases inadequate and warrants remand by the Board to address this potential theory of secondary service connection. Service connection for hypertension is granted. A claim for secondary service connection requires medical evidence that connects the asserted secondary disability to the service-connected disability. Velez v. West, 11 Vet. App. 148, 158 (1998). To establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The United States Court of Appeals for Veterans Claims (Court) held in the case of Ward v. Wilkie, 31 Vet. App. 233 (2019), that aggravation pursuant to 38 C.F.R. § 3.310 does not require a permanent worsening of the condition. Rather, the Court explained, "aggravation" is any incremental increase in disability attributable to the service-connected disability, i.e., any additional impairment of earning capacity that is above the degree of disability existing before the increase, regardless of its permanence. Id. As an initial matter, the record reflects the Veteran has a current diagnosis of hypertension, and he is service connected for a psychiatric and back condition, which satisfies the first and second elements of a claim for secondary service connection. Wallin, 11 Vet. App. at 512. The crux of the case concerns whether there is a nexus between the Veteran's hypertension and his service-connected psychiatric and/or back condition. Regarding this, a November 2017 letter from a nurse practitioner indicates she had been the Veteran's primary care provider for the past year and states, "[t]he back pain, neuropathy and leg weakness have contributed to anxiety and to hypertension." Further, a January 2024 VA examiner indicates that among the "various mechanisms described for the development of hypertension" is "increased activation of the sympathetic nervous system," which suggests a relationship between the Veteran's service-connected psychiatric condition and his hypertension. The Board acknowledges the November 2025 negative in, 11 Vet. App. at 512. The crux of the case concerns whether there is a nexus between the Veteran's hypertension and his service-connected psychiatric and/or back condition. Regarding this, a November 2017 letter from a nurse practitioner indicates she had been the Veteran's primary care provider for the past year and states, "[t]he back pain, neuropathy and leg weakness have contributed to anxiety and to hypertension." Further, a January 2024 VA examiner indicates that among the "various mechanisms described for the development of hypertension" is "increased activation of the sympathetic nervous system," which suggests a relationship between the Veteran's service-connected psychiatric condition and his hypertension. The Board acknowledges the November 2025 negative nexus opinion of record where a VA examiner finds there is no evidence that the Veteran's hypertension worsened beyond natural progression by any of the Veteran's service connected conditions. However, aggravation pursuant to 38 C.F.R. § 3.310 does not require a permanent worsening of the condition. Wallin, supra. As such, the Board finds the opinion to be inadequate. Further, the RO obtained a nexus opinion in December 2025. The examiner notes chronic pain can worsen hypertension. When pain persists, the examiner states, it triggers the sympathetic nervous system and affects the body's stress response system, which can increase stress hormones like norepinephrine and raise blood pressure. Further, the examiner notes sleep problems related to pain can also make it harder to control blood pressure. Further, the examiner finds while temporary anxiety can raise blood pressure, it does not lead to permanent hypertension; though, they further indicate, anxiety can worsen hypertension by keeping the sympathetic nervous system activated, raising cortisol levels, causing poor sleep, and leading to missed medications. The examiner also notes chronic anxiety can also create greater blood pressure swings, making it harder to manage blood pressure effectively. In addition to the November 2017 letter and the January 2024 VA examiner's notation, the Board finds the December 2025 examiner's findings, as to secondary service connection and aggravation, to be probative in resolving this matter. Accordingly, given the November 2017 letter and the January 2024 VA examiner's findings, in addition to the positive December 2025 VA nexus opinion, which indicates the Veteran's hypertension disability is secondary to his service-connected back condition and his service-connected psychiatric condition, the Board finds entitlement to service connection for hypertension is warranted under a theory of secondary service connection. 38 C.F.R. 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Thomas L. English Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Buck Denton 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.