HYPERTENSION

Summary

The Veteran, an Army veteran who served from October 1976 to May 1985, appeals the denial of service connection for hypertension. The claim was previously remanded for a VA medical opinion addressing the Veteran's theories of etiology and aggravation. The Board considered a January 2026 private medical opinion, which suggested an approximate balance of evidence regarding the hypertension's onset during service, noting limited service treatment records and the Veteran's testimony. However, it did not address the post-service diagnosis. A subsequent February 2026 VA medical opinion found no permanent aggravation of hypertension due to service-connected disabilities like lumbosacral strain or tinnitus, stating only temporary elevation of blood pressure was possible. The Board acknowledged the VA opinion's thoroughness but found it did not fully grasp the broad nature of secondary service connection post-Spicer and Ward, particularly regarding temporary aggravation. Citing the approximate balance of evidence and the need to resolve reasonable doubt in the Veteran's favor, the Board granted service connection for hypertension as secondary to his service-connected lumbosacral sprain, cervical strain, bilateral tinnitus, right ear hearing loss, and radiculopathy. The Board found that while the VA opinion did not support permanent aggravation, temporary aggravation from pain and stress could suffice, and given the limited longitudinal data and approximate balance, doubt was resolved in the Veteran's favor.

Rationale

Temporary aggravation may suffice for secondary service connection.; Evidence of record could be reasonably characterized as in approximate balance.; Resolved reasonable doubt in the Veteran's favor.

Full Decision Text

Citation Nr: 26004006
Decision Date: 03/31/26	Archive Date: 03/31/26

DOCKET NO. 17-52 793
DATE: March 31, 2026

ORDER

Entitlement to service connection for hypertension as secondary to service-connected lumbosacral sprain, cervical strain, bilateral tinnitus, right ear hearing loss, and radiculopathy of the bilateral lower extremities (sciatic and femoral) and bilateral upper extremities is granted.

FINDING OF FACT

Affording benefit of the doubt, the Veteran's hypertension is temporarily aggravated by his service-connected disabilities. 

CONCLUSION OF LAW

The criteria for service connection of hypertension has been met. 38 U.S.C. §§ 1131, 5103, 5103A 5107; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from October 1976 to May 1985.

The Veteran testified at a hearing before the undersigned Veterans Law Judge in February 2022. A transcript of the hearing is associated with the claims file.

This matter was most recently before the Board in December 2025 where the claim of service connection for hypertension was remanded in order to acquire a VA medical opinion which was responsive to the Veteran's theories regarding the etiology of his hypertension.

Having obtained a medical opinion regarding the Veteran's hypertension, the AOJ continued the denial of the claim in the February 2026 Supplemental Statement of the Case and returned the matter to the Board for further adjudication.

1. Entitlement to service connection for hypertension is granted.

Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

"Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected." 38 C.F.R. § 3.310(a). Secondary service connection is warranted where a non-service-connected disability would have been less severe "but-for" a service connected disability, either because there is an etiological link (to include worsening functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023). Temporary aggravation may suffice for secondary service connection. Ward v. Wilkie, 31 Vet. App. 223 (2019).

In the December 2025 remand, the Board specifically requested the examiner to address the Veteran's claim that his blood pressure was routinely elevated while in service, the Veteran's report of dizziness and seeing flecks while in service and the Veteran's routine exposure to carbon monoxide during service.

The AOJ procured a VA medical opinion in December 2025 which adequately responded to the Veteran's contentions and the December 2025 remand directives. See December 2025 C&P Examination.

In response, the Veteran submitted a January 2026 private medical opinion which asserted that an isolated in-service measurement of elevated blood pressure and the Veteran's lay testimony alongside the less-than-comprehensive nature of the Veteran's service treatment records create an approximate balance of evidence regarding whether the Veteran's hypertension arose during service. This opinion did not address the fact that the Veteran was first diagnosed with hypertension more than 20 years after discharge. Additionally, the private examiner opined that 

Even if it is not accepted that the Veteran's hypertension was directly caused by service, it is still at least as likely as not that the condition was aggravated beyond its natural chronic condition that can worsen over time, and when longitudinal blood pressure data are limited by missing records and absent separation examination, it is medically inappropriate to conclude that no in-service aggravation occurred solely due to lack of documentation.

See January 2026 Medical Treatment Record - Non-Government Facility.

To address the newly provided private medical opinion, the AOJ requested an additional examination to reconcile the conflicting medical evidence, opine as to a theory of direct service connection of the Veteran's hypertension, and to opine whether the Veteran's hypertension was "at least as likely as not aggravated beyond its natural progression by his/her service connected lumbosacral strain, cervical strain, radiculopathy [of all extremities ...], bilateral tinnitus, [... and] right ear hearing loss". See January 2026 Exam Request.

The AOJ procured a VA medical
, it is medically inappropriate to conclude that no in-service aggravation occurred solely due to lack of documentation.

See January 2026 Medical Treatment Record - Non-Government Facility.

To address the newly provided private medical opinion, the AOJ requested an additional examination to reconcile the conflicting medical evidence, opine as to a theory of direct service connection of the Veteran's hypertension, and to opine whether the Veteran's hypertension was "at least as likely as not aggravated beyond its natural progression by his/her service connected lumbosacral strain, cervical strain, radiculopathy [of all extremities ...], bilateral tinnitus, [... and] right ear hearing loss". See January 2026 Exam Request.

The AOJ procured a VA medical opinion in February 2026 which adequately responded to the Veteran's contentions; satisfied the December 2025 remand directive; addressed the conflicting opinions presented in the December 2025 VA opinion and the January 2026 private opinions; and addressed the theory of secondary service connection by aggravation of the hypertension by the Veteran's service-connected disabilities. The February 2026 VA examiner provided a negative nexus opinion as to all theories. For the theory of aggravation, the VA examiner opined in variations of the following:

... Pain from lumbosacral strain with degenerative disc disease can temporarily elevate blood pressure through acute sympathetic nervous system activation, but current evidence does not support permanent aggravation of blood pressure solely from these pain episodes. ... 

... While tinnitus can cause stress, etc. that leads to temporary increases in blood pressure through acute sympathetic activation, tinnitus does not result in permanent aggravation of hypertension. ...

See February 2026 C&P Examination. Although the February 2026 VA medical opinion was thorough, well-reasoned, and supported by an accurate factual basis, it failed to fully comprehend the vacuously broad nature of secondary service connection post Spicer and Ward. 

As noted above, secondary service connection is warranted where a non-service-connected disability would have been less severe "but-for" a service connected disability, either because there is an etiological link (to include worsening functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023). Temporary aggravation may suffice for secondary service connection. Ward v. Wilkie, 31 Vet. App. 223 (2019).

Here, the February 2026 VA examiner has provided medical evidence showing that although the Veteran's service-connected disabilities do not result in permanent aggravation of his hypertension they may result in temporary aggravation of his blood pressure. The Board observes that further medical opinions could be obtained to address whether a raising of blood pressure due to pain and stress amounts to additional functional impairment caused by the Veteran's hypertension. However, considering the number of prior appeals and that the evidence of record could be reasonably characterized as in approximate balance, the Board will refrain from seeking further inquiry into the matter that could possibly lead to prohibited remands for negative evidence. See Mariano v. Principi, 17 Vet. App. 305, 312 (2003).

As such, after careful consideration, the Board will resolve reasonable doubt in the Veteran's favor and find that the evidence is at least in approximate balance regarding whether his hypertension is secondary to all of his service-connected disabilities. 38 U.S.C. §§ 1131, 5103, 5103A 5107; 38 C.F.R. §§ 3.303, 3.310. Accordingly, entitlement to service connection for hypertension is granted. 

 

 

T. MAINELLI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Biggs, Andrew J.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.