Secondary service connection

Conditions secondary to hypertension

Veterans with service-connected hypertension often claim other conditions as caused or worsened by it. This page lists those conditions, what VA needs to grant them, and how they fared when veterans appealed to the Board of Veterans' Appeals.

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:

  1. A current diagnosis of the secondary condition.
  2. Hypertension is already service connected.
  3. Medical evidence linking them (a nexus opinion): the secondary condition was caused by hypertension (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).

Conditions claimed secondary to hypertension

Conditions the Board decided at least 300 times as secondary to this disability, highest appeal grant rate first. Open one for the evidence and reasons behind the decisions.

Hypertension claimed secondary to other conditions

The other direction: hypertension claimed as caused or worsened by a different service-connected disability.

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.

RatingCriteria
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.

All Board decisions on hypertension, direct and secondary: Hypertension grant rates.

Rules that apply to secondary claims

Research your secondary case

Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.

Which conditions secondary to hypertension does the Board grant most often, and why?What nexus opinions win claims secondary to hypertension?Why does the Board deny conditions claimed secondary to hypertension?
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