HYPERTENSION

Summary

The veteran, who served in the U.S. Navy from May 1988 to May 1994, appeals the denial of service connection for hypertension, claimed as secondary to his service-connected left knee osteoarthritis. The Board reviewed the evidence of record, including VA examinations from February 2023 and December 2024, and private treatment records. The veteran argued for secondary service connection for hypertension, citing a diagnosis of diastolic dysfunction and renal hypertension. However, the Board found that the VA examinations were inadequate as they relied on an incorrect diagnosis of hypertension rather than the diagnosed conditions of diastolic dysfunction and renal hypertension. The Board noted that "renal hypertension" presupposes a causal kidney condition, and while the veteran has chronic kidney disease stage 2, it is not service-connected. The Board also found that the evidence did not establish that the diagnosed renal hypertension or diastolic dysfunction were related to service or to a service-connected condition. The Board acknowledged the veteran's participation in toxic risk exposure activities (TERA) but found no duty to assist error by the agency of original jurisdiction, as the relevant diagnoses were not in the evidence at the time of the prior decision. Service connection for hypertension was denied.

Rationale

No adequate medical opinion linking diastolic dysfunction to service or service-connected condition.; No adequate medical opinion linking renal hypertension to service or service-connected condition.; VA examinations based on incorrect diagnosis and did not consider diagnosed conditions.; Renal hypertension presupposes a causal kidney condition, which is not service-connected.; Evidence persuasively weighs against service connection.

Full Decision Text

Citation Nr: A26039314
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 251216-614708
DATE:   April 28, 2026

ORDER

Entitlement to service connection for hypertension, to include as secondary to service-connected left knee osteoarthritis, is denied.

FINDING OF FACT

Neither the Veteran's diastolic dysfunction nor his renal hypertension onset in service; nor did either of these conditions onset within a year of separation from service; nor is either of these conditions otherwise related to service, to include as secondary to service-connected left knee osteoarthritis.

CONCLUSION OF LAW

The criteria for entitlement to service connection for hypertension, to include as secondary to service-connected left knee osteoarthritis, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from May 1988 to May 1994. 

The rating decision on appeal was issued in January 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

In May 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the issue on appeal, which was most recently addressed in a May 2023 rating decision. In January 2025, the agency of original jurisdiction (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. 

In the December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the January 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. The Board acknowledges that, in the December 2025 VA Form 10182, the Veteran noted his concurrent submission of medical evidence and waived the remainder of the 90-day evidence window. 

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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

VA regulations provide that, "[u]pon request, a claimant is entitled to a hearing on any issue involved in a claim... before VA issues notice of a decision on an initial or supplemental claim." 38 C.F.R. § 3.103(d)(1). That regulation does not indicate that the claimant is entitled to pre-decisional notice of this optional hearing. In fact, 38 C.F.R. § 3.103(b)(1) provides that, following a decision, "[c]laimants and their representatives are entitled to notice of any decision made by VA affecting the payment of benefits or the granting of relief... [including] the right to a hearing on any issue involved in the claim as provided in paragraph (d) of this section...." Read together with § 3.103(d), the only notice § 3.103(b) requires is that a claimant be provided notice of the right for a hearing with notification of the decision (by definition, a post-decisional notice). In November 2022, VA amended VA Form 21-526EZ and in May 2024 VA amended VA Form 20-0995 to inform claimants of the right to a hearing at any time during the claims process. Both the VA Forms used in this appeal (VA Form 21-526
 payment of benefits or the granting of relief... [including] the right to a hearing on any issue involved in the claim as provided in paragraph (d) of this section...." Read together with § 3.103(d), the only notice § 3.103(b) requires is that a claimant be provided notice of the right for a hearing with notification of the decision (by definition, a post-decisional notice). In November 2022, VA amended VA Form 21-526EZ and in May 2024 VA amended VA Form 20-0995 to inform claimants of the right to a hearing at any time during the claims process. Both the VA Forms used in this appeal (VA Form 21-526EZ and VA Form 20-0995) were prior, unamended versions of the indicated forms. However, the Board finds that any error in the failure to inform the Veteran of the right to a pre-decisional hearing before the Regional Office (RO) was harmless error. 

In Bowen, the Court found that when a claimant is denied a hearing before the RO, there is no due process violation if he is subsequently offered the opportunity for a hearing before the Board, even if a hearing was not requested or conducted, as long as there is no violation of due process concerning the Board hearing opportunity. Bowen v. Shinseki, 25 Vet. App. 250, 253-4 (2012). The facts in the case can be differentiated on several levels, to include that the Veteran did not actually request an RO hearing and the issue in Bowen was not one of notice. Regardless, the Board cannot find a basis to conclude that the underlying holding and logic of the Bowen case would not lead to the same finding of no prejudicial error under the procedure and facts of this case. The January 7, 2025 notification letter informing the Veteran of the rating decision included a VA Form 20-0998, Your Right to Seek Review of Our Decision, outlining the Veteran's appeal options, to include a hearing before the Board. Additionally, in the December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran was provided with an option to request a hearing with a Veterans Law Judge. The Veteran instead selected evidence submission to be reviewed by a Veterans Law Judge, and the form explicitly states that by choosing this option, the Veteran does not want a Board hearing. Because the Veteran was provided with notice of the right to appeal to the Board, as well as the right to a Board hearing, there was no due process violation in the processing of the claim or any suggestion that the Veteran was prejudiced by the failure of VA to provide a hearing at the RO level. See Bowen. 

SERVICE CONNECTION - HYPERTENSION 

The Veteran seeks service connection for hypertension, which he argued is secondary to his service-connected left knee osteoarthritis disability. Although the Veteran has asserted a theory of secondary service connection, VA must also consider a claim of direct service connection for hypertension. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires: (1) a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

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. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

When there is an approximate balance of positive and negative evidence regarding any
 causation exists when the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

When there is an approximate balance of positive and negative evidence regarding any material issue, the Secretary must give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. The benefit of the doubt doctrine applies "if the competing evidence is in 'approximate balance.'" Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc). However, "the benefit of the doubt rule does not apply [] when the evidence persuasively favors one side or the other" and is not in "approximate balance" or "nearly equal." Lynch at 781-782.

First, the Board considers whether the Veteran has diagnosed hypertension. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of section 1110 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

In the February 2023 and December 2024 VA examinations, the VA examiners noted that the Veteran stated that he was diagnosed with hypertension in 1994 and was taking medication for this condition. See February 2023 VA Examination; December 2024 VA Examination. This is listed solely as a recordation of medical history provided by the Veteran, not as a finding of the VA examiners. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (lay statements "simply recorded by a medical examiner" do not constitute "competent medical evidence"). Rather, the private treatment records supplied by the Veteran indicate that the Veteran was diagnosed with diastolic dysfunction, for which the medication cited by the VA examiners was prescribed. See, e.g., June 2022 Private Treatment Record. There is no evidence before the Board that diastolic dysfunction is synonymous with hypertension; nevertheless, diastolic dysfunction is a cardiovascular condition. 

The Board also acknowledges that "essential hypertension" is listed in the past medical history section of the Veteran's private medical records. See, e.g., October 2019 Private Treatment Record. With regard to the element of a current disability, current means near the time a claim is filed or at any time during its pendency. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). There was no indication from the records that this "past medical history" was a "current condition" for purposes of service connection. Moreover, as with the VA examinations, it is unclear whether the medical history notation was based on medical diagnostics or solely the report of the Veteran. 

Finally, with regard to the existence of a current condition, the Veteran has been diagnosed with renal hypertension. See, e.g., September 2025 Private Treatment Record. The evidence indicates that this condition was diagnosed in or around September 2025. See id. 

Thus, in conclusion, the first element of service connection - whether direct or secondary - has been met. The Veteran has two current cardiovascular disabilities: diastolic dysfunction and renal hypertension. 

The Board acknowledges the argument submitted by the Veteran's representative in December 2025, in which he stated that the Veteran had "a diagnosis of hypertension" as well as "a history of elevated systolic readings above 130mm Hg, and diastolic blood pressure over 80 mm Hg." The Board notes that, for VA purposes, a diagnosis of hypertension is defined as: diastolic blood pressure is predominantly 90mm or greater, as confirmed by readings taken two or more times on at least three different days; or systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm, as
 has two current cardiovascular disabilities: diastolic dysfunction and renal hypertension. 

The Board acknowledges the argument submitted by the Veteran's representative in December 2025, in which he stated that the Veteran had "a diagnosis of hypertension" as well as "a history of elevated systolic readings above 130mm Hg, and diastolic blood pressure over 80 mm Hg." The Board notes that, for VA purposes, a diagnosis of hypertension is defined as: diastolic blood pressure is predominantly 90mm or greater, as confirmed by readings taken two or more times on at least three different days; or systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm, as confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Elevated readings of the type, duration, and quantity described in the applicable diagnostic code are not included in the evidence of record. Additionally, the Board observes that the statement that the Veteran was diagnosed with "hypertension" is misleading, as the diagnosed "renal hypertension" is not the same condition as, e.g., "essential hypertension," since "renal hypertension" presupposes a causal condition (namely, a kidney condition). See Merriam-Webster Medical Dictionary. 

Following the February 2023 VA examination, the February 2023 VA examiner opined that the Veteran did not have hypertension while in service. Similarly, in the April 2023 VA medical opinion, the VA clinician opined that the Veteran did not have hypertension that onset in service, despite the existence of isolated high blood pressure readings in the service treatment records. Therefore, there is no evidence that the Veteran had hypertension while on active duty. 

As noted above, the VA examinations of record which concern hypertension are based on the Veteran's statement that he was diagnosed in 1994, as well as the prescription medication he was taking. The associated opinions do not consider the condition of diastolic dysfunction, which was the diagnosis for which medication was prescribed. See February 2023, April 2023, and December 2024 VA Medical Opinions. Thus, these opinions are not adequate with regard to establishing a nexus between the Veteran's diastolic dysfunction and the circumstances of service (see February 2023 and April 2023 VA Medical Opinions), nor between the Veteran's diastolic dysfunction and another service connected condition (see December 2024 VA Medical Opinion) because the opinions of record do not consider the actual condition with which the Veteran has been diagnosed. Similarly, none of the opinions of record consider the diagnosis of renal hypertension. See id. Thus, there is no adequate medical opinion of record because all medical opinions of record are based on an incorrect diagnosis. 

According to the Merriam-Webster Medical Dictionary, "renal hypertension" is the diagnosis used to identify hypertension that is associated with disease of the kidneys and is caused by kidney damage or malfunctioning. See "Renal hypertension." Merriam-Webster.com Medical Dictionary, https://www.merriam-webster.com/medical/renal%20hypertension. In this case, the Veteran was also diagnosed with "chronic kidney disease, stage 2." See November 2024 Private Treatment Record. Thus, the Board has considered whether the Veteran has a service-connected kidney condition to which renal hypertension may be secondarily service connected. The Veteran does not have a service-connected kidney disease. Therefore, entitlement to service connection for renal hypertension is not warranted on a secondary basis. 

Regarding diastolic dysfunction, there is no adequate medical opinion of record which links this condition to service or to a service-connected condition. Regarding renal hypertension, there is no adequate medical opinion of record which links this condition to service or to a service-connected condition. Therefore, entitlement to service connection is not shown by the evidence of record.

The Board acknowledges the Veteran's December 2025 argument that the evidence of a renal hypertension condition in conjunction with the December 2024 VA medical opinion connecting hypertension to the service-connected left knee osteoarthritis condition is sufficient to establish service connection on a secondary basis. However, as noted above, the VA examiner's December 2024 opinion was inadequate, as it was based on an incorrect diagnosis. Additionally, the type of hypertension with which the Veteran was diagnosed is, by definition, linked to kidney conditions. The Board finds this diagnosis, and associated etiology opinion, more probative because the Veteran's private treatment provider appears to have treated the Veteran for several years and has the benefit of additional testing in rendering the diagnosis. Thus, this medical diagnosis is significantly more probative than the Veteran's statements concerning his own diagnosis and, likewise, more probative than the VA medical opinion which relied on this inaccurate diagnosis. The left knee
 knee osteoarthritis condition is sufficient to establish service connection on a secondary basis. However, as noted above, the VA examiner's December 2024 opinion was inadequate, as it was based on an incorrect diagnosis. Additionally, the type of hypertension with which the Veteran was diagnosed is, by definition, linked to kidney conditions. The Board finds this diagnosis, and associated etiology opinion, more probative because the Veteran's private treatment provider appears to have treated the Veteran for several years and has the benefit of additional testing in rendering the diagnosis. Thus, this medical diagnosis is significantly more probative than the Veteran's statements concerning his own diagnosis and, likewise, more probative than the VA medical opinion which relied on this inaccurate diagnosis. The left knee osteoarthritis is not a kidney condition, nor is there evidence before the Board that the Veteran's kidney condition was caused or aggravated by the left knee osteoarthritis. Therefore, the evidence remains against a finding of secondary service connection. 

The Board notes that the AOJ as a duty to assist the Veteran, to include obtaining adequate medical opinions. However, in AMA, this duty only applies to the period before the rating decision on appeal. As the Veteran did not submit evidence concerning his cardiovascular diagnoses until after the rating decision on appeal, there was no pre-decisional duty to assist error for the correction of which this claim may be remanded. 38 C.F.R. § 20.802 (a).

The Board also acknowledges that the Veteran participated in a toxic risk exposure activity (TERA) in service as a result of which he may have been exposed to asbestos and radiation. Ordinarily, under the SFC Heath Robinson Honoring Our PACT Act, Pub. L. 117-168, 136 Stat. 1759 ("PACT Act"), examinations and opinions are mandated in situations where a Veteran has been diagnosed with a cardiovascular condition, such as renal hypertension or diastolic dysfunction, and there is evidence of possible TERA participation in service. However, under the AMA, remand is only appropriate if there has been a pre-decisional duty to assist error committed by the AOJ and/or for correction of any other AOJ error in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the claim. 38 C.F.R. § 20.802 (a). Since the diagnoses of renal hypertension and/or diastolic dysfunction were not in the evidence before the AOJ at the time of the January 2025 rating decision on appeal, there was no duty to assist error in failing to obtain such a medical opinion pursuant to the PACT Act. 

Additionally, the Board observes that the private treatment records produced by the Veteran in the post-appeal evidence window are records of the provider the Veteran identified in his May 2024 VA Form 20-0995 Supplemental Claim and in the June 2024 VA Form 21-4142a, General Release for Medical Provider Information. VA made two attempts to obtain these records and received a response that there were "no records found." See July 2024 Correspondence. Therefore, the Board finds that the AOJ satisfied its duty to attempt to obtain private treatment records. 

The Board has also considered presumptive service connection for renal hypertension as a chronic disease under 38 C.F.R. § 3.309; however, there is no probative evidence that the Veteran initially experienced renal hypertension (as defined in 38 C.F.R. § 4.104) in service, or within a year from separation from service, nor is there evidence that he has consistently experienced it since that time. Therefore, service connection for renal hypertension is not warranted as a chronic condition under 38 C.F.R. § 3.309.

Based on the forgoing, the evidence persuasively weighs against entitlement to service connection for a cardiovascular condition, to include diastolic dysfunction and renal hypertension. As the evidence is persuasive, the benefit of the doubt rule does not apply and service connection is denied. 38 U.S.C. § 5107 (b) (2018); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

 

 

Mariah N. Sim

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L.C. Reader, Associate Counsel

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.