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.

Positive nexus opinions track with higher hypertension grant rates

Hypertension decisions with a positive nexus opinion were granted on the merits 64.7% of the time, against 28.3% without one.

Common reasons for claim denials

The Board denied 32.1% of the 53,517 hypertension decisions in the data. The most cited denial reason was no in-service complaints, treatment or diagnosis, in 2,028 decisions. Next came the preponderance of the evidence against the claim, in 1,868, and a VA examiner finding the condition less likely than not related, in 1,656. Silent service records appeared in 1,192 denials and no current diagnosis in 836. Decisions with lay statements were granted at 31.0% versus 49.7% without them. The data does not show why.

Medical nexus letter requirements

A private opinion went with grants at 42.9% versus 31.4% without. A treating physician opinion went with 50.8% versus 34.4%. The gap is wider for sleep apnea secondary to hypertension: 91.7% with a positive nexus and 26.3% without. Negative nexus opinions appeared in 26,634 hypertension decisions, far more than the 8,385 with positive ones.

Hypertension grant rate on the merits, with and without each evidence type
WithWithout

Positive nexus opinion

64.7%
28.3%

Treating physician opinion

50.8%
34.4%

Private opinion

42.9%
31.4%

Favorable VA exam

58.7%
31.2%

Board decisions decided on the merits. Associations only; the data does not show that any evidence type caused a grant.

Continuous medication requirements for the lowest ratings

Among Board rating grants, 10 percent was assigned in 75.1% of cases, or 1,009 grants. A 0 percent rating appeared in only 0.1%, just 2 grants. Requiring continuous medication for control was a grant reason in 269 rating decisions and 321 service connection grants. The leading rating denial reason was criteria for a higher rating not met, in 2,833 decisions.

Hypertensive heart disease evaluation

Heart codes fared better on the merits than DC 7101. DC 7005 issues were granted on the merits 40.1% of the time and DC 7007 issues 27.6%, versus 24.8% under DC 7101. Under DC 7101 the most common rating was 10 percent, in 94.6% of grants. Under DC 7007 it was 60 percent, in 50.0% of grants, but only 30 issues used that code.

Granted on the merits by diagnostic code in hypertension rating issues
Granted on merits

DC 7101

24.8%

DC 7005

40.1%

DC 7017

39.4%

DC 7007

27.6%

DC 7017 and DC 7007 rest on small issue counts.

Figures from the research data as of Nov 2, 2026. Every number is computed from the data, which is extracted by AI from public decisions and can contain errors.

Rules that apply to secondary claims

Research your secondary case

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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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Where this data comes from

  1. Claim
  2. Regional office decides
  3. Veteran appeals
  4. Board decides
  5. Granted · Denied · Remanded: back to the regional office

Board of Veterans' Appeals decisions show how VA's highest review body applies 38 CFR and weighs evidence on contested claims.

Each one is an appeal: a regional office decided the claim first, and the veteran appealed. So these rates describe the Board, not a veteran's odds at the regional office, where most claims are decided and whose decisions are not public.

More on what Board decisions can and cannot tell you