HYPERTENSION

Summary

The veteran, who served from September 1970 to September 1972, including service in Vietnam, appeals the denial of service connection for hypertension. The veteran claims hypertension is secondary to his service-connected psychiatric disorder, specifically unspecified trauma and stressor related disorder with anxiety. The Board reviewed multiple medical opinions. A private physician in October 2015 opined PTSD was related to hypertension, but lacked rationale. A March 2016 VA examiner opined hypertension was less likely than not related to PTSD, citing lack of complications. A May 2018 VA examiner found hypertension existed prior to PTSD and was not aggravated by it, citing comorbidities. A March 2019 private examiner opined PTSD contributed to hypertension, but lacked rationale. A February 2020 VA examiner found hypertension worsened with PTSD-related stress and cited research linking PTSD to hypertension. An addendum to this opinion in January 2021 found hypertension at least as likely as not due to the service-connected psychiatric disorder, explaining the link between anxiety and hypertension. The Board found the February 2020 opinions probative due to their rationale and the link between the veteran's psychiatric disorder and hypertension. Additionally, as of August 2022, hypertension is presumptively linked to herbicide exposure due to Vietnam service. Resolving all doubt in the veteran's favor, the Board granted service connection for hypertension.

Rationale

Competent diagnosis of hypertension since October 1999.; Presumed herbicide exposure due to Vietnam service.; Probiric February 2020 VA examiner opinions linking anxiety/PTSD to hypertension.; Resolving all doubt in Veteran's favor.

Full Decision Text

Citation Nr: A26037676
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 210505-157803
DATE: April 22, 2026

ORDER

Service connection for hypertension is granted.

FINDING OF FACT

The Veteran's hypertension is aggravated by his service-connected unspecified trauma and stressor related disorder and anxiety disorder with chronic sleep impairment (psychiatric disorder), and the Veteran served on active duty in Vietnam, and herbicide agent exposure is presumed.

CONCLUSION OF LAW

The criteria for service connection for hypertension are met.  38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1970 to September 1972.

This case is before the Board of Veterans' Appeals (Board) on appeal from an April 2021 supplemental claim decision from a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).

In April 2021, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection for hypertension most recently addressed in a March 2021 rating decision.  In April 2021, the AOJ issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.

The Veteran elected the Hearing docket in the May 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement).  A Board hearing was held in November 2024.

Therefore, the Board may only consider the evidence of record at the time of the April 2021 supplemental claim decision on appeal, and any evidence the Veteran or their representative submitted 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 April 2021 supplemental claim decision on appeal and prior to the November 2024 Board hearing, or (2) more than 90 days following the November 2024 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 submitted evidence that the Board could not, 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 claims, 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 for a current disability that resulted from an injury, disease, or aggravation while in active service.  38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a).  Generally, service connection requires (1) a present disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the present disability and the in-service incurrence or aggravation of a disease or injury.  See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may alternatively be granted on a secondary basis for a disability that is proximately due to, the result of (caused), or worsened beyond its natural progression (aggravated) by a service-connected disease or injury.  Allen v. Brown, 7 Vet. App. 439, 448-49 (1995) (en banc); 38 C.F.R. § 3.310.

Service connection may also be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, air, or space service, during the period beginning on January 9, 1962, and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam.  38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 
 C.F.R. § 3.310.

Service connection may also be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, air, or space service, during the period beginning on January 9, 1962, and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam.  38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313.  

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act was enacted on August 10, 2022, and it added hypertension to the list of diseases that are deemed associated with herbicide agent exposure under VA law in 38 U.S.C. § 1116 and 38 C.F.R. § 3.309(e).  See PACT Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022).

Notwithstanding the foregoing presumption provisions for herbicide exposure, a claimant is not precluded from establishing service connection with proof of direct causation.  38 U.S.C. § 1113(b); Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994).

A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.  See Stefl v. Nicholson, 21?Vet. App.?120, 124 (2007).  Neither a VA medical examination report nor a private medical opinion is entitled to any weight in a service-connection or rating context if it contains only data and conclusions.  Nieves-Rodriguez v. Peake, 22?Vet. App.?295, 304 (2008).

The Veteran is competent to report symptoms and experiences he can observe.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a).  VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 C.F.R. § 3.102.

Service connection for hypertension.

The Veteran believes his hypertension is due to his psychiatric disorder.

A review of the record demonstrates that service connection for hypertension as secondary to a psychiatric disorder and as due to presumed herbicide agent exposure is warranted.

The record contains a competent diagnosis of hypertension since October 1999; accordingly, competent evidence of a current disability is found.

The Veteran is presumed to have been exposed to herbicide agents as his service included time in Vietnam.

An October 2015 private physician's assistant opined that the Veteran's posttraumatic stress disorder (PTSD) was related to his hypertension.

A March 2016 VA examiner opined that the Veteran's hypertension is less likely as not proximately due to or the result of the Veteran's service-connected PTSD because hypertension is not one of the complications of PTSD.

A May 2018 VA examiner opined that the Veteran's hypertension is less likely as not proximately due to or the result of PTSD because the Veteran's diagnosis of hypertension existed prior to his PTSD diagnosis.  Further, the examiner did not find objective medical evidence to indicate aggravation of Veteran's blood pressure by his PTSD.  The examiner explained that while PTSD symptomology may cause short term elevations in blood pressure there is no evidence in the Veteran's medical records to suggest aggravation beyond natural progression directly caused by PTSD because the Veteran has multiple comorbidities that may impact his hypertension, including long term alcohol use, obesity, hyperlipidemia, and sleep apnea.

A March 2019 private examiner opined that the Veteran's PTSD contributes to his hypertension.

A February 2020 VA examiner opined that the Veteran's hypertension worsens with increasing stress due to episodes of PTSD.  The examiner explained that the Veteran's hypertension has been treated along with his
 did not find objective medical evidence to indicate aggravation of Veteran's blood pressure by his PTSD.  The examiner explained that while PTSD symptomology may cause short term elevations in blood pressure there is no evidence in the Veteran's medical records to suggest aggravation beyond natural progression directly caused by PTSD because the Veteran has multiple comorbidities that may impact his hypertension, including long term alcohol use, obesity, hyperlipidemia, and sleep apnea.

A March 2019 private examiner opined that the Veteran's PTSD contributes to his hypertension.

A February 2020 VA examiner opined that the Veteran's hypertension worsens with increasing stress due to episodes of PTSD.  The examiner explained that the Veteran's hypertension has been treated along with his PTSD at the VA for at least the past 10 years.  PTSD has been shown to be linked to hypertension, the risk of high blood pressure, and other issues, including substance abuse, obesity, coronary artery disease, and suicide, and a growing body of research shows PTSD may also be linked to high blood pressure.  The examiner cited medical research supporting these findings.

The February 2020 VA examiner provided an addendum opinion in January 2021, finding that hypertension is at least as likely as not due to the Veteran's unspecified trauma and stressor related disorder with anxiety.  The examiner explained that anxiety may lead to high blood pressure, and high blood pressure may trigger feelings of anxiety, and that anxiety causes many physical symptoms, including increased heart rate, shallow breathing, and temporarily increased blood pressure.  The examiner explained that the Veteran's hypertension worsens with increasing stress due to episodes of anxiety and stress, and that anxiety and stress has been shown to be linked to hypertension.  The examiner noted that the Veteran's psychiatric disorder stems from service and is similar to PTSD and can cause the same reactions in the body leading to hypertension.  A mental health disorder that stems from a traumatic or life-threatening event, has been previously linked to risk of high blood pressure and other issues, including substance abuse, obesity, coronary artery disease, and suicide.  The examiner concluded that PTSD does appear to increase the risk of hypertension.

The Board finds the October 2015 and March 2019 opinions inadequate as they provided no rationale or necessary context.  See Stefl, 21?Vet. App. at 124; Nieves-Rodriguez, 22?Vet. App. at 304.

The Board affords the March 2016 opinion little probative weight because the examiner offered a conclusory rationale that hypertension is not a complication of PTSD, without discussion of aggravation or the medical principles later discussed by the February 2020 examiner.  See id.

The Board finds the May 2018 VA examiner's opinion inadequate because the conclusions were not supported with an analysis that the Board could consider and weigh against contrary opinions.  See Stefl, 21?Vet. App. at 124.

The Board finds the February 2020 VA examiner's opinions probative because they were based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data.  Nieves-Rodriguez, 22 Vet. App. at 304 (2008).

Although several opinions refer to PTSD, the February 2020 examiner in the January 2021 addendum explained that the Veteran's service-connected unspecified trauma and stressor related disorder with anxiety is similar to PTSD and can produce the same physiologic responses relevant to hypertension; therefore, the Board finds those discussions relevant to the claimed secondary nexus.

Additionally, as of August 10, 2022, the Veteran's hypertension is presumptively related to his in-service herbicide agent exposure.

?

Upon review of the record, the Board finds the evidence demonstrates that the Veteran's current hypertension is due to service.  Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  The claim is granted.

 

 

R. FEINBERG

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Costa, Stephanie D.

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.