HYPERTENSION

Summary

The Veteran, a Veteran who served from September 1978 to September 1981, appeals the denial of service connection for hypertension. The Veteran claims that his hypertension is secondary to a service-connected depressive disorder, which in turn is linked to chronic foot pain experienced since service. The Board reviewed lay assertions, service treatment records (STRs), service personnel records (SPRs), private and VA treatment records, a March 2021 VA examination report, and an April 2025 private medical opinion. The March 2021 VA examiner opined that hypertension was unlikely related to the service-connected depression, citing that hypertension onset preceded depression onset and that service records were negative for psychiatric issues. However, the Board found this opinion limited in probative value because the October 2018 VA examination, which granted service connection for depression, stated depression resulted from chronic foot pain and noted that service records were negative for hypertension. The Board also considered a private medical opinion from April 2025, which supported the Veteran's claim by linking hypertension to depression and its consequences. Given the approximate balance of evidence, the Board invoked the doctrine of reasonable doubt, granting service connection for hypertension. The Board found the evidence did not clearly weigh against the claim, thus granting the appeal.

Rationale

Hypertension diagnosed.; Evidence divided on secondary link to depression.; VA opinion found unlikely due to pre-existing depression; Board found opinion limited.; Private opinion supported link.; Approximate balance of evidence invoked benefit of doubt.

Full Decision Text

Citation Nr: A26035885
Decision Date: 04/16/26	Archive Date: 04/16/26

DOCKET NO. 210616-166385
DATE: April 16, 2026

ORDER

Entitlement to service connection for hypertension is granted. 

FINDING OF FACT

There is an approximate balance of positive and negative evidence indicating that hypertension is due to service-connected psychiatric disability.  

CONCLUSION OF LAW

The criteria for service connection for hypertension are met.  38 U.S.C. § 1131; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1978 to September 1981.    

This matter comes to the Board of Veterans' Appeals (Board) on appeal of a March 2021 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO).

In June 2021, the Veteran appealed the case to the Board by filing a VA Form 10182, notice of disagreement, against the decision.  He elected to appear before a Board hearing, which was conducted in March 2025.  See 38 C.F.R. § 20.302.  A transcript of the hearing is included in the claims file and has been reviewed.  

In this decision, the Board may only consider evidence of record at the time of the rating decision on appeal and any evidence submitted during the hearing and within 90 days following the hearing.  38 C.F.R. § 20.302.  If the Veteran wishes to pursue this matter further, information for doing so is included with this decision.

Service Connection

The Veteran asserts that he developed hypertension as the result of a service-connected depressive disorder.    

Laws and regulations 

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. § 1131; 38 C.F.R. § 3.303.  

To establish a right to compensation for a present disability, a Veteran 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 active service.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009).

Service connection also may be established on a secondary basis for a disability which is caused by service-connected disease or injury.  38 C.F.R. § 3.310 (a).  Establishing service connection on a secondary basis requires evidence showing (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by service-connected disability.  38 C.F.R. § 3.310 (a).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  To deny a claim, the evidence must clearly weigh against the claim.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

	Evidence and analysis 

The evidence in this matter consists of lay assertions, service treatment records (STRs), service personnel records (SPRs), private and VA treatment records, a March 2021 VA examination report and opinion, and an April 2025 private medical opinion.    

For the following reasons, a grant of the claim is warranted.  

First, the medical evidence shows that the Veteran has been diagnosed with hypertension.      

Second, the evidence is divided with regard to whether the hypertension resulted from service-connected depressive disorder.    

Certain evidence counters the claim.  

The Veteran asserts that hypertension resulted from depression connected to chronic foot pain during and since service.    

The only VA medical opinion of record addressing the claim, however, counters the claim.  The March 2021 examiner found it unlikely that hypertension related to service-connected depressive disorder.  In support, the examiner stated that hypertension onset occurred prior to depression onset.  Certain evidence supports this finding.  The STRs, an August 1981 discharge report of medical examination, and an August 1983 report of medical history are negative for psychiatric problems.  The record contains no medical evidence indicating treatment for a psychiatric problem in the years following service.  And the earliest medical evidence indicating a psychiatric disorder is dated in the mid-2000s, over 20 years after service.  See Horn v. Shinseki
 and since service.    

The only VA medical opinion of record addressing the claim, however, counters the claim.  The March 2021 examiner found it unlikely that hypertension related to service-connected depressive disorder.  In support, the examiner stated that hypertension onset occurred prior to depression onset.  Certain evidence supports this finding.  The STRs, an August 1981 discharge report of medical examination, and an August 1983 report of medical history are negative for psychiatric problems.  The record contains no medical evidence indicating treatment for a psychiatric problem in the years following service.  And the earliest medical evidence indicating a psychiatric disorder is dated in the mid-2000s, over 20 years after service.  See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012).     

The VA opinion is limited in probative value, however.  

The RO's October 2018 grant of entitlement to service connection for a depressive disorder is based on an October 2018 VA examination report and opinion.  The opinion states that depression has resulted from chronic foot pain the Veteran has had since service.  This opinion undermines the March 2021 VA opinion's rationale that hypertension could not be due to depression because hypertension preexisted depression.  Indeed, the STRs, the August 1981 and August 1983 discharge reports, and the medical evidence dated in the years following service are negative for hypertension.  As such, the March 2021 VA opinion is not persuasive evidence against the claim.  See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion).    

The record also contains the April 2025 private opinion, which supports the Veteran's claim by stating that hypertension was due to the service-connected depression caused by the service-connected chronic foot pain.  This opinion is backed by the otherwise unsupportive March 2021 VA opinion insofar as it contains a section stating that hypertension is among the several diseases which may result from depression and its consequences such as poor diet and lack of physical exercise.  See Bloom, supra.    

Based on this evidentiary background, the Board cannot find that the evidence demonstrates that hypertension is not secondary to service-connected depressive disorder.  See 38 C.F.R. § 3.310.  Rather, there is an approximate balance of positive and negative evidence on the issue.  See Lynch, supra.    

As such, this is an appropriate case in which to invoke VA's doctrine of reasonable doubt, grant the Veteran the benefit of the doubt, and grant the claim.                  See 38 C.F.R. § 3.102.

 

 

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Christopher McEntee

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.