Vietnam veterans and hypertension after the PACT Act: a claim map

The claim map

A claim map follows one veteran's route: where they served, the condition VA presumes for that service, and the conditions that follow from it. Each box shows how the Board ruled at that step.

Where they served

Vietnam

Service in the Republic of Vietnam or its offshore waters, January 1962 to May 1975

59,560 Board decisions that name Vietnam

presumed by law38 U.S.C. 1116, PACT Act

Step 1 · presumed by law

Hypertension

33.3% granted

1,695 of 5,083 veterans · all hypertension claims 18.9%

secondary38 CFR 3.310(a)

Step 2 · claimed secondary to hypertension

82.0%granted when the same decision granted the hypertension

0.8%granted when it did not

Step 2 depends on step 1: a secondary claim needs a service-connected condition to attach to.

• Erectile dysfunction DC 7522

  53.1% · 34 of 64

  all veterans 36.2%→ may open special monthly compensation

• Hypertensive heart disease DC 7007

  73.3% · 44 of 60

  all veterans 47.7%

• Stroke (bleeding) DC 8009

  47.9% · 23 of 48

  all veterans 36.1%

• Sleep apnea DC 6847

  8.5% · 4 of 47

  all veterans 14.2%

• Arrhythmia DC 7010

  57.8% · 26 of 45

  all veterans 41.6%

• Kidney disease DC 7502

  77.5% · 31 of 40

  all veterans 59.4%

• Valvular heart disease DC 7000

  50.0% · 9 of 18

  all veterans 34.0%

• Heart failure DC 7020

  77.8% · 14 of 18

  all veterans 38.3%

• Migraine / headaches DC 8100

  23.5% · 4 of 17

  all veterans 19.4%

• Coronary artery disease DC 7005

  18.8% · 3 of 16

  all veterans 31.4%

• Glaucoma DC 6013

  6.3% · 1 of 16

  all veterans 13.6%

• Nerve damage, legs DC 8520

  18.8% · 3 of 16

  all veterans 11.8%

Bar: share granted in Board decisions that name Vietnam (one count per veteran; a remand counts as not granted). Red mark: all veterans with the same claim. Step 2 counts claims decided in the same decision; conditions with at least 15 veterans.

Is hypertension presumptive for Vietnam veterans?

Yes, since the PACT Act took effect in August 2022. Hypertension is on the herbicide list in 38 U.S.C. 1116, so a veteran with qualifying service in Vietnam does not need a medical opinion linking it to service (M21-1 VIII.i.1.C.1.f). In decisions that name Vietnam, the Board granted 33.3% of hypertension claims, against 18.9% for all veterans.

The presumption covers the link between the exposure and the hypertension. The claim still has to show qualifying service and a diagnosis; VA's manual does not require hypertension to reach a set level of disability for the presumption. 59,560 Board decisions from 2020 to 2025 name Vietnam.

How much did the PACT Act change Board outcomes?

A lot. In decisions that name Vietnam, the Board granted 13.5% of hypertension claims in 2020 and 63.0% in 2023, the first full year after the law. The share was 44.6% in 2025, and fewer claims reached the Board: 363 in 2025, against 1,167 in 2020.

Decisions that name VietnamAll veterans

2020

13.5%

10.2%

2021

16.6%

12.9%

2022

37.4%

20.5%

2023

63.0%

26.2%

2024

53.3%

23.3%

2025

44.6%

21.6%

Share of decided claims granted; a remand counts as not granted. One count per veteran. Service-connection claims only. Hypertension joined the herbicide list on August 10, 2022.

All veterans' hypertension claims rose too, but much less. Part of the drop after 2023 may be that VA's regional offices now grant the clearer claims, so fewer reach the Board; the data does not show why.

What effective date applies?

Hypertension is not a covered disease under the Nehmer rules for earlier effective dates (M21-1 VIII.i.2.B), so those rules do not apply. In a recent decision below, the Board kept the effective date at August 2022, when the law took effect.

Why are Vietnam hypertension claims still denied?

For 920 denials, the Board's note named a medical link in 71.1% of them and the exposure or service in 41.3%. Before August 2022, the claim needed a medical opinion linking the hypertension to the exposure.

What follows from hypertension

Under 38 CFR 3.310(a), a condition caused by a service-connected one is service connected too. In the same decisions, 559 veterans had a claim secondary to hypertension.

Claimed secondary to hypertension	Granted	Veterans	Share	All veterans
Erectile dysfunction	34	64	53.1%	36.2%
Hypertensive heart disease	44	60	73.3%	47.7%
Stroke (bleeding)	23	48	47.9%	36.1%
Sleep apnea	4	47	8.5%	14.2%
Arrhythmia	26	45	57.8%	41.6%
Kidney disease	31	40	77.5%	59.4%
Heart failure	14	18	77.8%	38.3%

What conditions follow from hypertension?

Heart and kidney conditions most often. In the same decisions, hypertensive heart disease was granted for 44 of 60 veterans (73.3%), kidney disease for 31 of 40 (77.5%) and erectile dysfunction for 34 of 64 (53.1%).

Sleep apnea is the exception: it was rarely granted secondary to hypertension. When the same decision granted the hypertension, 82.0% of the claims secondary to it were granted. Where the hypertension was not on appeal, usually because it was already service connected, 33.5% were.

Read the decisions

Recent decisions, with the Board's reasoning as summarized by AI:

• A25110822, December 2025: hypertension granted on the herbicide presumption under the PACT Act for service in Vietnam, with a positive VA nexus opinion as well.
• A25108274, December 2025: hypertension granted on the presumption, for service in the territorial waters of Vietnam.
• A25111147, December 2025: hypertension had been granted under the PACT Act effective August 2022; the Board denied an earlier effective date.
• A25106208, December 2025: hypertension claimed from service aboard the USS Constellation, denied; the Board found the evidence weighed against service connection, including an unfavorable VA opinion.

What the data cannot tell you

The Vietnam group comes from the places each decision names; a mention is not proof of qualifying service, and it includes ships off the coast that may not qualify. Service-connection claims only; rating appeals are left out. The second step counts only claims decided in the same decision. Denial notes are AI-extracted. These are historical outcomes, not predictions.

For representatives

• Confirm qualifying service in Vietnam or its offshore waters; the presumption does the rest of the link.
• A hypertension claim denied before August 2022 can be filed again as a supplemental claim under the new law.
• Once hypertension is service connected, screen for heart and kidney conditions, stroke and erectile dysfunction.
• Expect the effective date to start no earlier than August 2022 on the presumption.