Secondary service connection
Hypertension secondary to PTSD: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided hypertension claimed as secondary to PTSD in 3,194 decisions. It granted the issue in 16.5% of them, close to the 17.6% grant rate for all hypertension issues, denied it in 19.8%, and remanded it in 61.6%. Counting only decisions on the merits, 45.4% were granted.
Decisions
3,194
2017–2026
Granted
16.5%
All hypertension: 17.6%
Granted on the merits
45.4%
Granted ÷ (granted + denied)
Remanded
61.6%
Denied: 19.8%
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 PTSD: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 316 | 12.3% | 33.2% | 48.4% | 6.0% |
| 2018 | 384 | 14.1% | 24.2% | 57.0% | 4.7% |
| 2019 | 406 | 15.3% | 16.7% | 66.3% | 1.7% |
| 2020 | 446 | 11.2% | 23.5% | 63.2% | 2.0% |
| 2021 | 442 | 11.1% | 23.8% | 64.7% | 0.5% |
| 2022 | 342 | 18.4% | 12.0% | 68.1% | 1.5% |
| 2023 | 274 | 23.0% | 14.2% | 62.0% | 0.7% |
| 2024 | 269 | 21.6% | 14.9% | 63.6% | 0.0% |
| 2025 | 234 | 26.5% | 12.0% | 60.3% | 1.3% |
| 2026 | 97 | 33.0% | 12.4% | 53.6% | 1.0% |
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 | 653 | 86.6% | 20.5% | +66.1 pts |
| Favorable VA exam | 359 | 76.6% | 37.7% | +38.9 pts |
| Private medical opinion | 985 | 64.0% | 30.9% | +33.1 pts |
| Treating physician opinion | 198 | 68.0% | 43.4% | +24.7 pts |
| Combat service | 368 | 42.9% | 45.8% | −3.0 pts |
| Lay statement | 2,264 | 37.6% | 75.9% | −38.3 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 79.7% of the decisions that granted hypertension.
- The Board found the veteran's statements credible in 21.2% of grants and 8.5% 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 | 2,102 | 40.7% | 62.3% | −21.6 pts |
| Unfavorable VA exam | 2,512 | 42.6% | 66.0% | −23.4 pts |
How these claims are argued
A secondary claim says PTSD 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)
12.5%
granted, of 1,476 issues (46.0% of all)
Causation only
caused by the disability, 3.310(a)
20.1%
granted, of 1,734 issues (54.0% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “Private and VA opinions acknowledged obesity as a factor in hypertension.” A26023051 (2026) Denied “The VA examiner cited risk factors like age, obesity, and tobacco use as more likely contributors.” A26000274 (2026) | 244 | 16.8% |
Stress Granted “VA opinion found no nexus between stress and long-term hypertension” A26001058 (2026) Denied “Objective testing (EKG, stress test, echocardiogram) normal.” A26005136 (2026) | 147 | 23.8% |
Sleep disruption Granted “Medical treatises cited linking PTSD/sleep impairment to hypertension.” 25004992 (2025) Denied “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.” A25063307 (2025) | 23 | 30.4% |
Chronic pain Granted “Private physician provided nexus opinion linking hypertension to PTSD and chronic pain.” A26032942 (2026) Denied “Private opinion lacked rationale for nexus to chronic pain.” 23003290 (2023) | 16 | 31.3% |
Reduced activity or mobility Granted “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.” A25072783 (2025) Denied “Examiners cited genetics, family history, age, obesity, and inactivity as primary risk factors.” 22013735 (2022) | 14 | 21.4% |
Medication side effects Granted “Private medical opinion found hypertension more likely than not related to PTSD and NSAID use.” A25062964 (2025) Denied “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.” 1727932 (2017) | 13 | 30.8% |
Nerve involvement Granted “PTSD affects nerve activity and blood pressure regulation.” 21060930 (2021) Denied “Medical literature does not support nexus between hypertension and PTSD, TBI, cervical strain, radiculopathy, ED, or DJD..” 21047437 (2021) | 13 | 7.7% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 13.9% of the 3,210 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
- Current diagnosis established69
- Service connection established49
- Caused by the service-connected disability38
- Aggravated by the service-connected disability29
- Secondary to PTSD10
- VA examiner: less likely than not related to service9
- Hypertension diagnosed5
- Granted as secondary to PTSD4
Most common reasons in denials
- VA examiner: less likely than not related to service164
- No in-service complaints, treatment or diagnosis113
- Preponderance of the evidence against the claim68
- Service records negative or silent60
- No current diagnosis31
- No continuity of symptomatology24
- Current diagnosis established16
- Aggravated by the service-connected disability12
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
Secondary service connection granted; Substantial weight to private opinion; PTSD impacts heart and vascular function
Current diagnosis of hypertension established.; Obesity identified as intermediate step between MST/PTSD and hypertension.; Evidence supports obesity caused by MST and PTSD.
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
No evidence of in-service incurrence; Private opinion lacked probative value (speculative, correlational); No presumptive service connection (late onset)
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
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
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.
- PTSD is already service connected.
- Medical evidence linking them (a nexus opinion): hypertension was caused by PTSD (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 PTSD
- Major depressive disorder secondary to PTSD305 decisions · 62.0% granted
- Migraine secondary to PTSD1,732 decisions · 37.1% granted
- Sleep apnea secondary to PTSD11,479 decisions · 31.7% granted
- Erectile dysfunction secondary to PTSD1,645 decisions · 30.3% granted
- Gastroesophageal reflux disease (GERD) secondary to PTSD1,237 decisions · 25.3% granted
- Irritable colon syndrome (spastic colitis mucous colitis) secondary to PTSD380 decisions · 24.2% granted
- Diabetes mellitus secondary to PTSD551 decisions · 20.3% granted
Hypertension secondary to other conditions
See all conditions secondary to PTSD 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 PTSD, 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.