HYPERTENSION

MARTIN B. PETERS · 2026 · Case ID: 26004650

GRANTED

Summary

The veteran, who served from June 1972 to June 1994, appeals the denial of service connection for hypertension. The case has a complex procedural history, with multiple remands from the Board of Veterans' Appeals (Board) since August 2016. The Board reviewed the evidence to determine if hypertension was incurred in service, aggravated by service, or secondary to a service-connected condition. The veteran had normal enlistment examinations but exhibited elevated blood pressure readings during service and reported a history of high blood pressure in 1993 and 1994. Service connection for obstructive sleep apnea (OSA) was granted in December 2016, which is relevant for secondary claims. The Board found the May 2023 private medical opinion from Dr. A.B.K. to be the most probative, as it linked the veteran's hypertension to his service-connected OSA and noted the onset of cardiovascular issues during service. This opinion was authored by the veteran's treating doctor and provided a reasoned medical explanation. Previous VA examination opinions were found inadequate due to internal inconsistencies, inaccurate factual premises, or lack of a nexus opinion. The Board granted service connection for hypertension based on the adequate private opinion, finding it related to service.

Rationale

May 2023 private opinion by treating doctor found hypertension related to OSA and noted onset during service.; Previous VA opinions were inadequate due to inconsistencies or lack of nexus.; Benefit of the doubt applied in favor of the veteran.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-00 038A

Full Decision Text

Citation Nr: 26004650
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 17-00 038A
DATE: April 16, 2026

ORDER

Service connection for hypertension is granted.

FINDING OF FACT

The evidence of record demonstrates that the Veteran's hypertension was incurred in or otherwise the result of military service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from June 1972 to June 1994.

This case comes before the Board of Veterans' Appeals (Board) from an August 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), hereinafter the Agency of Original Jurisdiction (AOJ), which, in pertinent part declined to readjudicate the claim for service connection for hypertension because the evidence submitted was not new and material. In a January 2019 Board decision, the Board found new and material evidence and reopened the claim for service connection for hypertension, and then remanded the claim for further development. The Board also remanded the claim in June 2021, December 2021, and May 2023. The case now returns to the Board for appellate review.

Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Where a veteran served continuously for 90 days or more during active service, service connection for certain chronic diseases, including hypertension, may also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a).

Furthermore, if evidence of a chronic disability is shown in service or during the presumptive period, but is later diagnosed, such disability may still be service connected based on continuity of symptomatology. In this regard, evidence of a chronic disease shown either in service (or within an applicable presumptive period under 38 C.F.R. § 3.307, usually one year) and with chronic and continuous manifestations either beginning in service or since discharge from service, may permit service connection on the basis of continuity of symptomatology, unless otherwise attributable to an intercurrent cause. See 38 C.F.R. § 3.303(b). The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology, however, can be applied only in cases involving those conditions explicitly enumerated under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause
Cir. 2013).

Turning to the evidence of record, the Veteran was diagnosed with hypertension during the appeal period. See April 2017 VA examination. As such, the first element of service connection for hypertension is met.

During service, the Veteran's enlistment examination was normal, the Veteran had high blood pressure readings in service, and the Veteran noted on his reports of medical history in 1993 and 1994 that he had a history of high blood pressure. See Service Treatment Records (STRs). Additionally, the Veteran was granted service connection for OSA in December 2016. See December 2016 Rating Decision. As such, the second element of service connection, for direct service connection and on a secondary basis, is met.

Turning to a nexus, the Board finds there is one adequate medical opinion of record-the May 2023 private opinion, and thus grants service connection under that opinion. The May 2023 private positive nexus opinion authored by A.B.K., MD, states,

The patient is already service connected for obstructive sleep apnea (OSA). On 8/29/2022. I provided a letter of support regarding the patients service connectivity requests. Support was based on the patient's well kept records documenting diagnosis of OSA while actively serving at 27 years of age. There was also medical records of elevated blood pressure at that time. Now, the patient continues to suffer from premature ventricular contractions (PVCs) and resistant hypertension. It is well understood and published in medical literature that OSA is strongly associated with cardiovascular disease and subsequent morbidity and mortality. OSA (especially when untreated/undertreated) increases sympathetic activity, and the downstream effects include hypertension. cardiac conduction abnormalities, and ultimately increased risk of myocardial infarction, congestive heart failure, and cerebrovascular accidents. Because of the strong association between OSA and the patient's other active cardiovascular-related conditions, as well as documentation of these disease processes starting while the patient was actively serving. I continue to support the patient's application for service connectivity.

The Board finds this opinion to be of probative value because it contains a reasoned medical explanation with clear conclusions and supporting data, and it is authored by the Veteran's treating doctor. See Stefl, supra; Kowalski, supra; Guerrieri, supra. The Board notes this opinion is one of causation but also direct service connection in that it states that hypertension is a downstream effect of OSA, but also states that the disease processes (to include hypertension) started while on active service.

The Board acknowledges the other medical opinions of record, but finds they are inadequate. The opinions are as follows:

In March 2019, direct service connection opinions were provided by a VA examiner; however, the opinions are internally inconsistent as well as inconsistent with the factual record. First, the opinions state that the Veteran had a one-time increase in blood pressure during service, but the Veteran had multiple episodes of elevated blood pressure, not just one. Additionally, one opinion states that the Veteran had hypertension in service, but it was acute and undiagnosed, and is unrelated to current hypertension; however, this does not take into account the fact that hypertension is a chronic disease and that the Veteran reported hypertension on his in-service June 1993 and May 1994 reports of medical history, which could indicate an in-service diagnosis. These opinions are therefore based on inaccurate/incomplete facts and as such are inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (an examination must be based on an accurate factual premise).

In August
complete facts and as such are inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (an examination must be based on an accurate factual premise).

In August 2021, a direct service connection opinion was provided by a VA examiner. The examiner opined,

The entire c-file was reviewed. 6/1993 report of medical history showed "Yes" to high or low BP - HTN 1977-1980 treated w/ weight loss and smoking cessation. 9/1988 report of medical exam BP 130/70 and 5/1994 report of medical exam for separation BP 130/72. The STRs show the HTN resolved w/ lifestyle modifications during service, there is a gap until a diagnosis of HTN in 2015. A nexus is not established.

The Board finds this opinion is inadequate in that the examiner did not address whether the in-service readings of elevated blood pressure were sufficient to identify hypertension or establish chronicity. Id.

In August 2022, the Veteran provided a private positive nexus opinion authored by A.B.K., MD; however, this opinion does not have a rationale. The opinion stated, "Based on my personal appointments with the patient, along with medical service records dating back to 27 years of age, I believe the patient was suffering from undiagnosed obstructive sleep apnea (OSA). I believe that OSA was the cause of his secondary hypertension at the time." As such, the Board is unable to use this opinion to grant service connection because it is overall conclusory without sufficient rationale. See Nieves, supra; Stefl, supra; Guerrieri v. Brown, 4 Vet. App. 467 (1993) (the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.).

In May 2025, the VA examiner provided a negative nexus secondary aggravation opinion for service-connected OSA and hypertension. The examiner stated,

Essential hypertension is a chronic condition with a multifactorial etiology, including genetics, age, diet, stress, and lifestyle factors. The natural course of hypertension typically involves a gradual increase in blood pressure over time, with possible development of end-organ damage depending on control and treatment. The 2017 ACC/AHA Guidelines emphasize that while secondary factors can influence blood pressure, most patients develop primary (essential) hypertension that follows a progressive course unless effectively managed. Per record review, veterans takes daily antihypertensive medications. OSA is associated with hypertension, particularly resistant hypertension, but association does not prove causation or pathological aggravation. In patients already diagnosed with essential hypertension, the presence of OSA does not necessarily worsen hypertension beyond its expected progression. Meta-analyses show that treating OSA with CPAP results in modest reductions in blood pressure (~2-3 mmHg), which indicates that OSA is not a primary driver of most cases of hypertension.

The Board notes that this opinion did not provide specific information regarding the Veteran's risk factors. Thus, it is inadequate. See Id.; Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998) (the failure of the physician to provide a basis for his/her opinion affects the weight or credibility of the evidence).

Finally, the Board notes that in the May 2025 secondary aggravation opinion, the VA examiner discussed service-connected COPD and pulmonary hypertension, while stating that the Veteran does not have pulmonary hypertension, but then never provided an opinion regarding essential hypertension as it relates to service-connected COPD. As such, there is no opinion for the actual diagnosed disorder. Id.

In sum, regarding a nexus, the evidence of record that is competent, credible, and probative is the May 2023 private opinion authored by A.B.K., MD, indicating onset of hypertension during military service and continuity of symptomology since that time. Accordingly, the Board finds that hypertension is related to the Veteran's active military service; therefore, service connection is warranted. See 38 C.F.R. § 3.303, 3.307, 3.309.

In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt
but then never provided an opinion regarding essential hypertension as it relates to service-connected COPD. As such, there is no opinion for the actual diagnosed disorder. Id.

In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

MARTIN B. PETERS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Garfield, Jeannine F.

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.

Analyze in VA Law Explorer