HYPERTENSION

KRISTI L. GUNN · 2026 · Case ID: A26020159

GRANTED

Summary

The veteran, who served in the Army from June 1987 to July 1987 with subsequent National Guard service, sought service connection for hypertension. The veteran contended that his hypertension developed due to weight gain caused by his service-connected lumbosacral strain, which limited his physical activity. The Board reviewed the evidence, including a July 2023 opinion from an APRN and a September 2022 opinion from a physician's assistant. Both medical professionals opined that the veteran's hypertension was at least as likely as not secondary to, related to, or aggravated by his service-connected lumbosacral strain and subsequent weight gain. They cited medical literature supporting the link between chronic pain, reduced activity, obesity, and hypertension. The Board found these opinions to be highly probative due to their adequate rationale and reliance on medical literature, despite acknowledging a negative VA nexus opinion. The Board afforded the positive opinions greater weight, finding the veteran's claim for service connection for hypertension as secondary to his lumbosacral strain to be granted. The decision noted that while obesity itself cannot be service-connected, it can act as an intermediate step between a service-connected disability and a secondary condition.

Rationale

Positive nexus opinions from C.M.B. (PA) and P.L.D. (APRN) found hypertension at least as likely as not secondary to service-connected lumbosacral strain with subsequent weight gain.; Medical literature cited by the professionals supports the link between chronic pain, reduced activity, obesity, and hypertension.; Board afforded greater probative weight to the positive nexus opinions over a negative VA nexus opinion.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251204-611840

Full Decision Text

Citation Nr: A26020159
Decision Date: 03/05/26 Archive Date: 03/05/26

DOCKET NO. 251204-611840
DATE: March 5, 2026

ORDER

Entitlement to service connection for hypertension is granted.

FINDING OF FACT

The Veteran's hypertension is related to his service-connected lumbosacral strain, to include obesity as an intermediary step.

CONCLUSION OF LAW

The criteria for service connection for hypertension have been met. 38 U.S.C.

§§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1987 to July 1987 with subsequent service in the Army National Guard.

The rating decision on appeal was issued in December 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In September 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a September 2023 decision. In December 2024, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior September 2023 decision.

In a December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the September 2023 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1110.

Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury.

38 U.S.C. § 1131; 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra.

According to the United States Court of Appeals for the Federal Circuit in Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021), the proper standard of review is whether the factors are in an "approximate balance." Lynch held that the veteran is entitled to the benefit of the doubt when the evidence is in an approximate balance, i.e., nearly equal and does not require the evidence to be in exact equipoise. Id.

1. Entitlement to service connection for hypertension is granted.

The Veteran is seeking to establish service connection for hypertension. Specifically, the Veteran contends that his hypertension developed due to weight gain caused by his service-connected lumbosacral strain. In a July 2023 statement, the Veteran reported that due to his back condition, exercising became painful and over time, completely hindered him from exercising. This resulted in him gaining a significant amount of weight. The Veteran noted he was 200 pounds at the time he separated from service and currently weighed 314 pounds.

VA's Office of General Counsel has determined that obesity is not a disease or injury under VA's laws and regulations and may not be service connected on a direct or secondary basis. VAOPGCPREC 1-2017. However, obesity may act as an intermediate step between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310(a). See Marcelino v. Shulkin, 29 Vet. App. 155 (2018); Walsh v. Wilkie, 32 Vet. App. 300 (2020).

A theory of obesity as an intermediary step is raised when there is some evidence in the record that draws an association or suggests a relationship between the veteran's obesity (or weight gain resulting in obesity) and a service-connected condition. Garner v. Tran, 33 Vet. App. 241, 248 (2021). The General Counsel's opinion advises that to decide entitlement to secondary service connection in such a case, the Board is required to resolve (1) whether the service-connected disability caused the veteran to become obese; (2) if so, whether obesity, as a result of the service-connected disability, was a substantial factor in causing the claimed secondary disability; and (3) whether the claimed secondary disability would not have occurred but for obesity caused by the service-connected disability. VAOPGCPREC 1-2017 at 9-10; Garner, 33 Vet. App. at 247-248.

Here, the Veteran is diagnosed with hypertension and is service-connected for lumbosacral strain. As such, the remaining question is whether they are related, to include obesity as an intermediate step.

In a September 2022 opinion, C. M. B., a physician's assistant, opined that the Veteran's hypertension was as least as likely than not secondary to, related to, and/or aggravated by his service-connected lumbosacral strain with subsequent weight gain. C. M. B. explained that individuals suffering from chronic pain were at higher risk of gaining weight and becoming obese due to several factors including decreased activity. C. M. B. referenced multiple studies confirming the relationship between chronic pain and obesity. Further, he explained that weight gain/obesity, such as that the Veteran suffered from, was known to increase blood pressure and at the very least, aggravate pre-existing hypertensive conditions. Current medical literature suggested a nexus between weight gain and blood pressure levels. C. M. B. concluded that the Veteran's total weight gain of approximately 115 pounds since service to the present was as least as likely as not due to his service-connected lumbosacral strain which then as least as likely as not led to the development of his hypertension. C. M. B.'s opinion contained citations to and abstracts of medical literature used to support the opinion.

In a July 2023 opinion, P. L. D., an advanced practice registered nurse (APRN), opined that the Veteran's hypertension was as least as likely as not secondary to, related to, and/or aggravated by his service-connected lumbosacral strain with subsequent weight gain. P. L. D. noted that due to the chronic pain associated with the Veteran's service-connected lumbosacral strain, he had participated in less physical activities and led a more sedentary lifestyle. This was a contributing factor to his weight gain. Citing multiple studies, P. L. D. explained that individuals suffering from chronic pain were at a higher risk for gaining weight and becoming obese. She concluded that medical literature supported a nexus between the Veteran's conditions based on a musculoskeletal condition causing a decrease in physical activity and functional limitations due to chronic pain consequently promoting weight gain and an obesity condition that triggered a sympathetic nervous system activation and contributed to the development of hypertension.

The Board affords the positive nexus opinions of September 2022 and July 2023 great probative weight, as they were offered by medical professionals that reviewed the Veteran's record and supported their opinions with adequate rationale and citations to medical literature. While the Board is aware there is a negative VA nexus opinion of record, it finds no reason to afford that opinion greater probative weight.

For these reasons, the Veteran's claim of entitlement to service connection for hypertension as secondary to his service-connected lumbosacral strain is granted.

KRISTI L. GUNN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Silverblatt, L.

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.

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