Secondary service connection
Hypertension secondary to a psychiatric disorder: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided hypertension claimed as secondary to a psychiatric disorder in 1,789 decisions. It granted the issue in 18.9% of them, close to the 17.6% grant rate for all hypertension issues, denied it in 17.8%, and remanded it in 62.0%. Counting only decisions on the merits, 51.4% were granted.
Decisions
1,789
2017–2026
Granted
18.9%
All hypertension: 17.6%
Granted on the merits
51.4%
Granted ÷ (granted + denied)
Remanded
62.0%
Denied: 17.8%
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 psychiatric disorder: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 94 | 10.6% | 26.6% | 57.4% | 5.3% |
| 2018 | 182 | 10.4% | 20.9% | 65.4% | 3.3% |
| 2019 | 187 | 16.0% | 19.8% | 63.6% | 0.5% |
| 2020 | 234 | 15.8% | 21.4% | 61.1% | 1.7% |
| 2021 | 224 | 17.9% | 23.7% | 56.7% | 1.8% |
| 2022 | 195 | 18.5% | 12.3% | 68.7% | 0.5% |
| 2023 | 216 | 16.7% | 14.4% | 68.1% | 0.9% |
| 2024 | 189 | 22.2% | 11.1% | 66.7% | 0.0% |
| 2025 | 188 | 29.3% | 12.2% | 58.0% | 0.5% |
| 2026 | 88 | 37.5% | 19.3% | 43.2% | 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 | 430 | 84.8% | 23.9% | +61.0 pts |
| Private medical opinion | 618 | 68.4% | 33.3% | +35.1 pts |
| Favorable VA exam | 211 | 74.0% | 46.0% | +28.0 pts |
| Treating physician opinion | 105 | 71.2% | 49.8% | +21.4 pts |
| Buddy statement | 49 | 50.0% | 51.5% | −1.5 pts |
| Combat service | 87 | 48.3% | 51.6% | −3.3 pts |
| Lay statement | 1,360 | 43.8% | 85.8% | −42.1 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 76.0% of the decisions that granted hypertension.
- The Board found the veteran's statements credible in 20.1% of grants and 7.5% 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 | 1,136 | 46.0% | 65.2% | −19.3 pts |
| Unfavorable VA exam | 1,363 | 48.0% | 70.7% | −22.7 pts |
How these claims are argued
A secondary claim says a psychiatric disorder 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)
16.7%
granted, of 743 issues (41.3% of all)
Causation only
caused by the disability, 3.310(a)
20.3%
granted, of 1,054 issues (58.7% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “Obesity as intermediate step” 26004219 (2026) Denied “Hypertension attributed to genetics, obesity, and lifestyle..” 26000629 (2026) | 159 | 25.8% |
Stress Granted “Private medical opinion linked hypertension to service-connected PTSD and in-service stressors” A26028875 (2026) Denied “The Veteran sought service connection for hypertension, claiming it was secondary to his service-connected bowel issues and stress.” 26000629 (2026) | 109 | 23.9% |
Chronic pain Granted “December 2025 VA examiner found chronic pain can worsen hypertension via sympathetic nervous system activation and sleep issues..” 26002222 (2026) Denied “Private opinion lacked rationale for nexus to chronic pain.” 23003290 (2023) | 24 | 50.0% |
Sleep disruption Granted “Service-connected for persistent depressive disorder with alcohol use disorder and insomnia.” A25037550 (2025) Denied “Veteran has current hypertension and service-connected insomnia/anxiety/alcohol use disorder.” A25021919 (2025) | 24 | 20.8% |
Medication side effects Granted “The Board found that while VA examinations were inadequate or did not fully address the veteran's risk factors, the May 2020 opinion noting a nexus to NSAID and alcohol use related to service-connected conditions raised reasonable...” 25011081 (2025) Denied “The veteran claimed entitlement to service connection for hypertension, alleging it was secondary to his service-connected depression and joint disabilities, potentially due to medication side effects.” 20043214 (2020) | 16 | 25.0% |
Reduced activity or mobility Denied “Service connection for hypertension was denied, claimed as secondary to obesity caused by inactivity due to the service-connected back condition and/or acquired psychiatric disorder.” 23013980 (2023) | 12 | 0.0% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 18.0% of the 1,797 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 disability61
- Current diagnosis established44
- Service connection established36
- Aggravated by the service-connected disability20
- Hypertension diagnosed5
- Service records negative or silent4
- Evidence evenly balanced4
- Secondary service connection granted3
Most common reasons in denials
- VA examiner: less likely than not related to service67
- No in-service complaints, treatment or diagnosis47
- Service records negative or silent35
- Preponderance of the evidence against the claim29
- Aggravated by the service-connected disability13
- No current diagnosis13
- No continuity of symptomatology13
- Continuity of symptomatology since service10
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
New and relevant evidence submitted in December 2024 warranted readjudication.; In-service elevated blood pressure readings noted.; Veteran provided competent and credible lay statements of continuity of symptomatology.; Evidence found to be in equipoise, resolving doubt in Veteran's favor.
Competent diagnosis of hypertension since October 1999.; Presumed herbicide exposure due to Vietnam service.; Probiric February 2020 VA examiner opinions linking anxiety/PTSD to hypertension.; Resolving all doubt in Veteran's favor.
Hypertension diagnosed.; Evidence divided on secondary link to depression.; VA opinion found unlikely due to pre-existing depression; Board found opinion limited.; Private opinion supported link.; Approximate balance of evidence invoked benefit of doubt.
Denied
No evidence of in-service chronicity, manifestation within presumptive period, or continuity of symptomatology.; Service treatment records silent regarding hypertension; post-service diagnosis years later.; No evidence of herbicide exposure to support presumptive claim.
No competent positive nexus opinion; VA examiner opined less likely than not caused by toxic exposure; Hypertension attributed to lifestyle factors
No in-service hypertension diagnosis; Negative VA nexus opinion; Psychiatric condition not service-connected
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 psychiatric disorder is already service connected.
- Medical evidence linking them (a nexus opinion): hypertension was caused by a psychiatric disorder (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 psychiatric disorder
- Migraine secondary to a psychiatric disorder1,181 decisions · 41.2% granted
- Sleep apnea secondary to a psychiatric disorder4,474 decisions · 33.1% granted
- Erectile dysfunction secondary to a psychiatric disorder1,061 decisions · 31.9% granted
- Gastroesophageal reflux disease (GERD) secondary to a psychiatric disorder591 decisions · 25.4% granted
- Diabetes mellitus secondary to a psychiatric disorder418 decisions · 21.3% granted
Hypertension secondary to other conditions
See all conditions secondary to a psychiatric disorder 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 psychiatric disorder, 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.