Secondary service connection
Hypertension secondary to a back condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided hypertension claimed as secondary to a back condition in 370 decisions. It granted the issue in 18.9% of them, close to the 17.6% grant rate for all hypertension issues, denied it in 21.6%, and remanded it in 58.1%. Counting only decisions on the merits, 46.7% were granted.
Decisions
370
2017–2026
Granted
18.9%
All hypertension: 17.6%
Granted on the merits
46.7%
Granted ÷ (granted + denied)
Remanded
58.1%
Denied: 21.6%
How VA rates hypertension
Once service connection is granted, VA assigns a disability rating from the rating schedule: 38 CFR 4.104, diagnostic code 7101 (Hypertensive vascular disease (hypertension and isolated systolic hypertension)). The rating is the same whether the condition is service connected directly or as secondary to another disability.
| Rating | Criteria |
|---|---|
| 60% | Diastolic pressure predominantly 130 or more |
| 40% | Diastolic pressure predominantly 120 or more |
| 20% | Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more |
| 10% | 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 |
- 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.
Text of 38 CFR 4.104 as of Feb 27, 2026. Confirm the current text at the source before relying on it.
See all hypertension decisions, direct and secondary.
Hypertension secondary to a back condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 21 | 14.3% | 33.3% | 38.1% | 14.3% |
| 2018 | 22 | 4.5% | 27.3% | 63.6% | 4.5% |
| 2019 | 29 | 6.9% | 24.1% | 69.0% | 0.0% |
| 2020 | 44 | 6.8% | 29.5% | 63.6% | 0.0% |
| 2021 | 46 | 19.6% | 28.3% | 52.2% | 0.0% |
| 2022 | 40 | 15.0% | 10.0% | 75.0% | 0.0% |
| 2023 | 44 | 36.4% | 11.4% | 52.3% | 0.0% |
| 2024 | 53 | 24.5% | 22.6% | 52.8% | 0.0% |
| 2025 | 55 | 25.5% | 16.4% | 58.2% | 0.0% |
Each row counts issues (each condition the Board decided), so the shares add up to 100%. Other: dismissed, withdrawn or no clear outcome. Years with fewer than 20 issues are left out.
Evidence in granted and denied hypertension decisions
For each kind of supporting evidence: how often the Board granted the hypertension issue on the merits when the decision mentioned it, compared with decisions that did not. These are associations, not causes, and evidence is recorded per decision, not per issue.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Positive nexus opinion | 89 | 81.4% | 24.2% | +57.2 pts |
| Private medical opinion | 141 | 61.0% | 29.4% | +31.6 pts |
| Lay statement | 285 | 35.3% | 90.3% | −55.0 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 77.1% of the decisions that granted hypertension.
- The Board found the veteran's statements credible in 11.4% of grants and 5.0% of denials.
Negative evidence in the record
An unfavorable exam or a negative nexus opinion often sits in the same record as favorable evidence, and the Board weighs them against each other. So these rows show how often hypertension was still granted when the record contained the negative item, not that the item helped.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Negative nexus opinion | 279 | 40.5% | 67.6% | −27.1 pts |
| Unfavorable VA exam | 310 | 40.5% | 89.5% | −49.0 pts |
How these claims are argued
A secondary claim says a back condition caused hypertension or made it worse, and names how. Below: whether the Board's decision discussed aggravation, and the medical link each decision names, with how often those issues were granted.
Aggravation discussed
made worse by the disability, 3.310(b)
10.7%
granted, of 159 issues (42.7% of all)
Causation only
caused by the disability, 3.310(a)
25.4%
granted, of 213 issues (57.3% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “(APRN) found hypertension at least as likely as not secondary to service-connected lumbosacral strain with subsequent weight gain.” A26020159 (2026) Denied “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,...” A26035946 (2026) | 115 | 28.7% |
Chronic pain Granted “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,...” 26004006 (2026) Denied “The veteran sought service connection for hypertension, claiming it was secondary to his service-connected lumbosacral strain due to pain and sleep disturbance.” A24077260 (2024) | 38 | 47.4% |
Nerve involvement Granted “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.” 26004006 (2026) Denied “Alternatively, he claims it is secondary to his service-connected low back disability with associated peripheral neuropathy, leading to obesity and subsequently hypertension.” A24077134 (2024) | 32 | 37.5% |
Reduced activity or mobility Granted “The veteran claims the back condition led to a sedentary lifestyle and weight gain, contributing to hypertension.” A25024422 (2025) Denied “Hypertension attributed to sedentary lifestyle and hypercholesteremia.” A25017056 (2025) | 30 | 26.7% |
Medication side effects Granted “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...” 24030807 (2024) Denied “VA examiner's opinion found less likely than not related to NSAID use” 24009488 (2024) | 11 | 27.3% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 46.2% of the 372 issues name at least one medical link; the rest only say “secondary to” the disability. One issue can name several links. Granted is the share of those issues granted (remands count as not granted). A link named in a denial was often the argument the Board rejected.
Why the Board granted or denied hypertension
Most common reasons in grants
- Caused by the service-connected disability14
- Service connection established10
- Current diagnosis established8
- Aggravated by the service-connected disability3
- Obesity as intermediate step3
- Hypertension would not have occurred but for obesity2
- Obesity as an intermediate step2
- Obesity was substantial factor in causing hypertension2
Most common reasons in denials
- VA examiner: less likely than not related to service22
- No in-service complaints, treatment or diagnosis14
- Preponderance of the evidence against the claim9
- Service records negative or silent7
- Caused by the service-connected disability5
- No current diagnosis4
- Aggravated by the service-connected disability4
- No continuity of symptomatology3
Numbers are decisions that gave the reason. Reasons are short phrases extracted by AI from each decision; common wordings of the same reason are grouped. Benefit of the doubt is reported above.
Recent hypertension decisions
Granted
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.
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.
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
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 medical explanation.
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.
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
What VA needs to grant a secondary claim
Secondary service connection means VA disability benefits for a condition caused or made worse by a disability that is already service connected (38 CFR 3.310). The claim needs three things:
- A current diagnosis of hypertension.
- A back condition is already service connected.
- Medical evidence linking them (a nexus opinion): hypertension was caused by a back condition (3.310(a)), or was made worse beyond its natural progress by it (aggravation, 3.310(b)).
VA's procedures for these claims are in M21-1 V.ii.2.D. When the evidence for and against is about even, VA must decide in the veteran's favor (38 CFR 3.102).
Other conditions secondary to a back condition
- Paralysis of sciatic nerve secondary to a back condition325 decisions · 57.8% granted
- Radiculopathy secondary to a back condition1,181 decisions · 49.9% granted
- Major depressive disorder secondary to a back condition770 decisions · 47.4% granted
- Paralysis of sciatic nerve or external popliteal nerve secondary to a back condition2,436 decisions · 38.7% granted
- Sleep apnea secondary to a back condition1,166 decisions · 38.2% granted
- Ulnar nerve paralysis secondary to a back condition628 decisions · 34.6% granted
- Peripheral nerve conditions secondary to a back condition307 decisions · 32.2% granted
- Peripheral nerve disorders secondary to a back condition1,204 decisions · 27.8% granted
- Erectile dysfunction secondary to a back condition619 decisions · 27.6% granted
- Degenerative arthritis of the spine secondary to a back condition679 decisions · 23.7% granted
- Urinary incontinence secondary to a back condition408 decisions · 22.8% granted
- Migraine secondary to a back condition347 decisions · 18.7% granted
- Hip impairment secondary to a back condition1,856 decisions · 13.6% granted
- Knee conditions secondary to a back condition2,083 decisions · 12.3% granted
- Ankle impairment secondary to a back condition322 decisions · 11.2% granted
- Cervical spine limitation of motion secondary to a back condition1,553 decisions · 8.8% granted
- Shoulder impairment secondary to a back condition647 decisions · 7.3% granted
- Foot impairment secondary to a back condition354 decisions · 6.2% granted
Hypertension secondary to other conditions
See all conditions secondary to a back condition or hypertension as a primary or secondary condition.
Rules that apply to secondary hypertension claims
- 38 CFR 3.310
Secondary service connection and aggravation
Read it in VA Law Explorer - M21-1 V.ii.2.D
Secondary service connection and aggravation of non-service-connected disabilities
Read it in VA Law Explorer - 38 CFR 3.102
Reasonable doubt (benefit of the doubt)
Read it in VA Law Explorer - 38 CFR 4.104 · DC 7101
Schedule of ratings: cardiovascular system
Read it in VA Law Explorer - M21-1 V.iii.5.3
Hypertension: definitions, blood pressure readings required, predominant blood pressure
Read it in VA Law Explorer - M21-1 V.iii.11.2.e
When hypertension is or is not a complication of diabetes
Read it in VA Law Explorer
Research your hypertension case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
How these numbers are calculated
- Counts decisions in which the Board decided a hypertension issue claimed as secondary to a back condition, by the outcome of that issue.
- The primary disability is read from the decision text ("secondary to …") and grouped by name, so spellings such as "PTSD" and "posttraumatic stress disorder" count together.
- Secondary claims also include aggravation of a non-service-connected condition by a service-connected one (38 CFR 3.310(b)).
- The data comes from CaseScribe's AI extraction of public BVA decisions (2017–2026) and can contain errors. It is updated automatically as new decisions are added.