HYPERTENSION

Summary

The Veteran, an Army veteran who served from November 1983 to July 1998, appeals the denial of service connection for hypertension. The Board reviewed the case under the AMA framework, considering evidence of record up to the July 2025 rating decision. The primary issue was whether hypertension is service-connected, either directly or secondarily to the Veteran's service-connected PTSD and obstructive sleep apnea. The Board found a current diagnosis of hypertension supported by VA treatment records and a January 2025 VA examination. The key evidence was a July 2025 private medical opinion from Dr. V.F., which concluded that the Veteran's hypertension was caused or aggravated by his service-connected PTSD and sleep apnea, citing well-established physiological mechanisms. The Board found this opinion persuasive, noting that the Veteran's medical history showed no alternative primary cause. While a January 2025 VA opinion concluded no secondary connection, the Board afforded it less weight due to a lack of explanation and failure to consider the sleep apnea connection. Applying the benefit-of-the-doubt rule, the Board found the evidence in equipoise and resolved the doubt in the Veteran's favor. Consequently, service connection for hypertension was granted.

Rationale

Current diagnosis of hypertension supported by VA treatment records and VA examination.; Private medical opinion found hypertension caused/aggravated by PTSD and sleep apnea.; VA opinion lacked explanation and did not consider sleep apnea connection.

Full Decision Text

Citation Nr: A26032094
Decision Date: 04/08/26	Archive Date: 04/08/26

DOCKET NO. 250805-574300
DATE: April 8, 2026

ORDER

Entitlement to service connection for hypertension is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, hypertension is related to the Veteran's service-connected posttraumatic stress disorder (PTSD) and obstructive sleep apnea.

CONCLUSION OF LAW

The criteria for entitlement to service connection for hypertension have been met.  38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from November 1983 to July 1998.  

This appeal is being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017.  115 Pub. L. No. 55, 131 Stat. 1105.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a March 2025 rating decision issued by a Department of Veterans Affairs (VA) regional office (RO), an agency of original jurisdiction (AOJ).

VA received the Veteran's VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in August 2025.  The Veteran elected the Direct Review docket.  

As a preliminary matter, in the August 2025 Notice of Disagreement for entitlement to service connection for hypertension, the Veteran identified the March 2025 rating decision.  Although the NOD was received within one year of an March 2025 rating decision, the AOJ readjudicated the issue on the merits in a subsequent July 2025 rating decision.  Notably, additional evidence was received after the March 2025 rating decision, which was of record at the time of the July 2025 rating decision.

The Board liberally construes the August 2025 Notice of Disagreement as appealing the July 2025 rating decision concerning entitlement to service connection for hypertension, which will permit the Board to take the most Veteran friendly approach and consider the most developed record.  The Board finds that Terry v. McDonough, 37 Vet. App. 1, 14-15 (2023) is not controlling in the instant matter because, unlike the circumstances in Terry, the Board's interpretation of the Notice of Disagreement as appealing the later decision does not preclude the Board from adjudicating the claim on the merits.

Accordingly, the Board will consider the evidence of record at the time of the July 2025 rating decision.  38 C.F.R. § 20.301.

In the July 2025 rating decision, the AOJ found that new and relevant evidence had been received to warrant readjudication of the claim for entitlement to service connection for hypertension.  38 C.F.R. § 3.104(c).  As this is a favorable finding which is binding on the Board in the absence of clear and unmistakable evidence to the contrary, the Board will proceed with adjudication of the claim on the merits.

As a final matter, the Board acknowledges that the time period to switch Board dockets with regard to the July 2025 rating decision has not yet elapsed.  See Williams v. McDonough, 37 Vet. App. 305 (2024).  However, as the Board is granting service connection for hypertension, the decision below represents a full grant of the benefits sought on appeal.  Thus, the Board finds no prejudice in proceeding with a decision at this time.

Entitlement to service connection for hypertension

The Veteran asserts that service connection is warranted for hypertension.

Service connection may be established for a disability resulting from disease or injury which was clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.  Establishing service connection generally requires medical or, in certain circumstances, lay 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.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Service connection may be established on a secondary basis for a disability
 discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.  Establishing service connection generally requires medical or, in certain circumstances, lay 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.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Service connection may be established on a secondary basis for a disability which is shown to be proximately due to, the result of, or chronically aggravated by, 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 (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc) (additional disability resulting from aggravation of a nonservice-connected disorder by a service-connected disorder is also compensable under 38 C.F.R. § 3.310).  The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value.  See Baldwin v. West, 13 Vet. App. 1, 8 (1999).

After reviewing the evidence of record, the Board concludes that service connection for hypertension is warranted.

Under the AMA, the Board must accept any favorable findings made by the AOJ in its adjudication of the claim, unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding.  38 C.F.R. § 3.104(c).  The July 2025 rating decision contains a favorable finding of a current diagnosis of hypertension, as shown in VA treatment records.  Additionally, a January 2025 VA examination reflects a current diagnosis of hypertension.  Thus, the AOJ's favorable finding demonstrates the first element of service connection: a current diagnosis.

In addition, the persuasive evidence of record is at least in equipoise as to whether the Veteran's hypertension is related to his service-connected PTSD and obstructive sleep apnea.  38 C.F.R. §§ 3.303, 3.310; see Allen, 7 Vet. App. 439 (holding that secondary service connection requires that evidence is sufficient to show that the current disability was either caused or aggravated by a service-connected disability).  In that regard, in a July 2025 private medical opinion, V.F., M.D., opined that the Veteran's hypertension was caused or aggravated by his service-connected PTSD and sleep apnea.  Dr. V.F. explained that chronic PTSD and obstructive sleep apnea are both independently capable of inducing and sustaining elevated blood pressure through well-established physiological mechanisms, noting that the Veteran's medical history showed no alternative primary cause.  Dr. V.F. found that the medical evidence, in combination with peer-reviewed medical literature, supported a "clear and probable medical relationship between these conditions and the development of his hypertension."  Dr. V.F. concluded that it was his expert medical opinion, offered to a reasonable degree of medical certainty, that the Veteran's hypertension was secondary to his service-connected PTSD and further aggravated by his obstructive sleep apnea.

The Board acknowledges the January 2025 VA opinion which concluded that the Veteran's hypertension was not secondary to his service-connected PTSD; however, the VA examiner only noted the pathogenesis of hypertension and the potential risk factors, but failed to provide any supporting explanation or rationale for the conclusion that hypertension was not caused or aggravated by the service-connected PTSD and/or sleep apnea.  Further, the VA examiner did not consider whether the Veteran's hypertension was caused or aggravated by his service-connected obstructive sleep apnea.  Accordingly, the Board does not afford the January 2025 VA opinion significant probative weight.

Pursuant to the "benefit-of-the-doubt" rule, where there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue.  38 U.S.C. § 5107(b).  Upon weighing the evidence of record, the Board finds that the evidence is at least in equipoise as to whether the Veteran's hypertension was caused or aggravated by his service-connected PTSD and obstructive sleep apnea.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's
-connected obstructive sleep apnea.  Accordingly, the Board does not afford the January 2025 VA opinion significant probative weight.

Pursuant to the "benefit-of-the-doubt" rule, where there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue.  38 U.S.C. § 5107(b).  Upon weighing the evidence of record, the Board finds that the evidence is at least in equipoise as to whether the Veteran's hypertension was caused or aggravated by his service-connected PTSD and obstructive sleep apnea.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, entitlement to service connection for hypertension is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

C. CRAWFORD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Katz, Michelle P.

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.