HYPERTENSION

JOHN J. CROWLEY · 2026 · Case ID: A26035946

DENIED

Summary

The veteran, who served from September 1973 to September 1993, appeals the denial of service connection for hypertension, both directly and as secondary to his service-connected back disability. The Board found no presumptive service connection for hypertension, as it was not diagnosed in service, did not manifest within the presumptive period, and lacked continuity of symptomatology. While the veteran claimed a 1993 diagnosis, the record showed only blood pressure readings and a follow-up note in 1998, with a formal diagnosis not appearing until 2011 according to a VA examiner. The Board also denied direct service connection, finding no evidence of hypertension in service or a causal link, and dismissed the veteran's argument that pre-hypertension readings in service records constituted evidence of incurrence. For the secondary claim, the Board gave greater weight to the May 2020 VA examiner's opinion, which found it less likely than not that hypertension was caused by the service-connected back disability, citing risk factors like tobacco use, family history, and obesity. The Board found the private nexus opinion lacked a reasoned medical explanation connecting the back disability to hypertension, assigning it no probative weight. Therefore, service connection for hypertension was denied.

Rationale

No presumptive service connection for hypertension.; Hypertension not diagnosed in service or within presumptive period.; No continuity of symptomatology from service.; No evidence of hypertension in service or causal link.; Pre-hypertension readings in service not considered diagnosis.; VA examiner found less likely than not that hypertension caused by back disability.; Private nexus opinion lacked reasoned medical explanation.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210607-164299

Full Decision Text

Citation Nr: A26035946
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 210607-164299
DATE: April 16, 2026

ORDER

Entitlement to service connection for hypertension, including as secondary to service-connected back disability, is denied.

FINDING OF FACT

The Veteran's hypertension was not incurred during his active service nor otherwise due to his military service including as secondary to service-connected back disability.

CONCLUSION OF LAW

The criteria for service connection for hypertension, including as secondary to service-connected back disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from September 1973 to September 1993.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2020 rating decision issued by the Department of Veterans Affairs (VA), Regional Office (RO), Agency of Original Jurisdiction (AOJ).

In July 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a May 2020 rating decision. In November 2020, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the prior May 2020 decision.

In the June 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A March 2025 Board hearing was held with the undersigned judge. A copy of the transcript has been associated with the Veteran's file.

Therefore, the Board may only consider the evidence of record at the time of the May 2020 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran [or representative] at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection will be granted if the evidence demonstrates a current disability resulted from an injury or disease incurred in or aggravated by active military service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of 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). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases (including hypertension) will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.
.R. § 3.303(d).

Service connection may also be granted on a secondary basis for a disability if it is 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 (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). An increase in severity of a nonservice-connected disease or injury shall not be service-connected if it is due to the natural progression of the nonservice-connected condition. Id. at 447-48. Service connection on a secondary basis may not be granted without medical evidence of a current disability and evidence of a nexus between the current disability and a service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512-14 (1998).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F. 3rd 1391 (2021).

Entitlement to service connection for hypertension.

The Veteran asserts that he was diagnosed with hypertension in 1993 before he was discharged from active service.

He also asserts in the alternative that his service-connected back disability has caused or aggravated his hypertension.

The May 2020 rating decision made the favorable finding that the Veteran has a current diagnosis of hypertension. The decision also found that the Veteran's claimed primary back disability is service connected. The Board is bound by the favorable findings of the AOJ, absent clear and unmistakable evidence to the contrary. 38 U.S.C. § 5104A; 38 C.F.R. § 20.801(a).

To start, there is no presumptive service connection available for the Veteran's chronic disease of hypertension. The Veteran asserts that his hypertension began in service and has continued.

In this case, hypertension was not shown in service, did not manifest to a compensable degree within the one-year presumptive period, and was not noted in service with attributable continuity of symptomatology. Although the Veteran and his representative testified in the March 2025 Board hearing that in 1993, before discharge, he was diagnosed with hypertension and told to follow up, the record shows a February 1998 VA treatment record with a handwritten note of "HTN" and note to followup. See March 2025 Hearing Transcript; see also, February 1998 VA treatment record. Even then, the record does not show a diagnosis of hypertension until over a decade later in 2011 noted by the May 2020 VA examiner. February 1998 is not within the presumptive period of one year after discharge. Therefore, service connection based upon the chronic disease presumption is not warranted.

The Board will now consider whether service connection is warranted for hypertension on a direct-incurrence basis. Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). In this case, while the record reflects that the Veteran has a diagnosis of hypertension, there is no evidence of hypertension in service or of a causal relationship between the Veteran's current disability and his military service. The Veteran asserts that his service treatment records (STRs) show high blood pressure readings during service and that, before discharge in 1993, he was diagnosed with hypertension. At the March 2025 Board hearing, the representative argued that the Veteran's blood pressure readings in STRs show pre-hypertension arguing that this is evidence that the Veteran's hypertension began during service. See March 202
bee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). In this case, while the record reflects that the Veteran has a diagnosis of hypertension, there is no evidence of hypertension in service or of a causal relationship between the Veteran's current disability and his military service. The Veteran asserts that his service treatment records (STRs) show high blood pressure readings during service and that, before discharge in 1993, he was diagnosed with hypertension. At the March 2025 Board hearing, the representative argued that the Veteran's blood pressure readings in STRs show pre-hypertension arguing that this is evidence that the Veteran's hypertension began during service. See March 2025 Hearing Transcript. The Board finds this argument unavailing. The Veteran's STRs indicate blood pressure readings, but there is no diagnosis of hypertension or readings indicating a diagnosis of hypertension. Therefore, service connection on a direct basis is not warranted.

It is important for the Veteran to understand that a high blood pressure reading is not the same as a diagnosed high blood pressure disability. The Veteran, from time to time, should expect to have high blood pressure. This is not the same as a finding of disability that began during service many years ago.

The Board will now consider service connection for hypertension on a secondary basis. The Veteran's alternative theory of entitlement is that his hypertension is secondary to his service-connected back disability.

The Veteran underwent a May 2020 VA Hypertension examination. The examiner confirmed the 2011 diagnosis of hypertension and the start of medication at that time.

The examiner opined that the Veteran has a positive history of tobacco use, family (sister and brother) history of hypertension, and obesity.

The examiner also opined that back pain may cause transient elevation in blood pressure but not sustained or permanent hypertension. The examiner reviewed the medical records showing a diagnosis of essential hypertension, which indicates high blood pressure with no secondary cause. The examiner concluded that it is less likely than not that his hypertension was caused by his lumbar strain and disc disease.

The Veteran submitted a June 2021 private nexus opinion from Dr. P.R. for chronic pain syndrome. The provider concluded that hypertension, immobility, weight gain and loss, as well as his service-connected back disability, could cause chronic pain syndrome.

In this regard, no one would suggest that this problem "could" never be caused by the back disability, the key question is if it at least as likely as not (generally a 50% chance or greater) the cause of this problem. In this regard, the opinion says little other than it "could" be the cause.

The Veteran also submitted a March 2025 Correspondence. He reports that he had a procedure done in September 1993, shortly after discharge, and was diagnosed pre and post operatively with high blood pressure. The record shows a September 1993 post surgery nursing note with blood pressure readings of 130/80, 154/71, 138/76 and 144/72. There was no diagnosis of hypertension in this record.

The Board finds the weight of the evidence is against the Veteran's claim and gives greater weight to the May 2020 VA examiner who found that the Veteran's essential hypertension is not secondary to his service-connected back disability. While the Veteran submitted a private nexus opinion, there was no rationale or discussion of a back disability causing hypertension. To have probative value, a medical examination report submitted to the Board must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Here, the medical report does not. As such, the Board assigns no probative weight to the private physician's opinion as it does not show a nexus between hypertension and his back disability, but an association of his disabilities including hypertension with chronic pain syndrome. On the other hand, the VA examiner explained that the Veteran has other risk factors such as a history of smoking, family history of hypertension, and being overweight. The Board also found evidence that the Veteran was not diagnosed with hypertension until 2011, decades after discharge from service. And the note advising a follow-up for hypertension was in February 1998. The post-operative blood pressure readings in September 1993 show no note regarding hypertension and no evidence of a diagnosis of hypertension as the Veteran and his representative discussed in the March 2025 Board hearing and most importantly, the blood pressure readings in September 1993 show no indication the readings represented a diagnosis of hypertension. The Board finds that service connection for hypertension on a secondary basis is also not warranted.

Accordingly,
that the Veteran has other risk factors such as a history of smoking, family history of hypertension, and being overweight. The Board also found evidence that the Veteran was not diagnosed with hypertension until 2011, decades after discharge from service. And the note advising a follow-up for hypertension was in February 1998. The post-operative blood pressure readings in September 1993 show no note regarding hypertension and no evidence of a diagnosis of hypertension as the Veteran and his representative discussed in the March 2025 Board hearing and most importantly, the blood pressure readings in September 1993 show no indication the readings represented a diagnosis of hypertension. The Board finds that service connection for hypertension on a secondary basis is also not warranted.

Accordingly, entitlement to service connection for hypertension, including as secondary to a back disability, is denied.

The evidence in this case is not in approximate balance to warrant application of the benefit-of-the-doubt rule. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

John J. Crowley

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Raborn, S.

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.

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