HYPERTENSIVE HEART DISEASE

Summary

The veteran, who served in the United States Marine Corps from June 1990 to June 1994 and had subsequent active duty periods in the United States Army, appeals the denial of service connection for left ventricular hypertrophy and Fabry's disease, claiming they are secondary to his service-connected hypertension. The Board reviewed the evidence under the Appeals Modernization Act. The veteran submitted a private cardiology opinion in September 2025, which opined that Fabry's disease was at least as likely as not aggravated by service-connected hypertension, citing NIH studies. A VA heart examination in October 2025 diagnosed left ventricular hypertrophy, noting its presence since service and progression, and opined that it was most likely caused by Fabry's disease and hypertension, establishing a secondary nexus. The Board found both the private opinion for Fabry's disease and the VA opinion for left ventricular hypertrophy adequate, noting the detailed rationale and direct contemplation of the conditions' relationship to hypertension. Although a negative TERA opinion was provided for left ventricular hypertrophy, it was not discussed as the other opinions were deemed sufficient. The Board granted service connection for both conditions as secondary to hypertension, affording the veteran the benefit of the doubt.

Rationale

VA heart examination found left ventricular hypertrophy.; Examiner opined condition was most likely caused by service-connected hypertension.; Secondary nexus established.

Full Decision Text

Citation Nr: A26039359
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 251017-599921
DATE: April 28, 2026

ORDER

Entitlement to service connection for left ventricular hypertrophy, as secondary to service-connected hypertension, is granted.

Entitlement to service connection for Fabry's disease, as secondary to service-connected hypertension, is granted.

FINDINGS OF FACT

1. The Veteran's left ventricular hypertrophy is etiologically related to the Veteran's service-connected hypertension.

2. The Veteran's Fabry's disease is etiologically related to the Veteran's service-connected hypertension.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for left ventricular hypertrophy, as secondary to service-connected hypertension, have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.3.

2. The criteria for entitlement to service connection for Fabry's disease, as secondary to service-connected hypertension, have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.3.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from June 1990 to June 1994.  He also had several active duty periods in United States Army; from October  2001 to March 3, 2002, from March 9, 2002 to August 2002, from March 2003 to May 2003 and from March 2005 to February 2007.  His awards and decorations include the Southwest Asia Service Medal, Kuwait Liberation Medal, and the Global War on Terrorism Service Medal, among others.

Evidentiary Windows

The rating decision on appeal was issued in October 2025; therefore, the modernized review system, known as the Appeals Modernization Act (AMA), applies.  In the October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Under the Direct Review docket, the Board is authorized to review only the evidence considered by the Agency of Original Jurisdiction (AOJ) at the time of the October 2025 rating decision.  The Board may not consider evidence presented outside of the timeframes discussed above.  Evidence provided following the October 2025 rating decision on appeal has not been considered by the Board in its decision on the claims.  38 C.F.R. §§ 20.300, 20.301, 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, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.

The Board notes that Veteran requested this case be advanced on the docket (AOD) due a serious illness of the Veteran.  See October 2025 and November 2025 VA Form 20-10207.  The Board granted this request in a March 2026 correspondence.  38 U.S.C. § 7107; 38 C.F.R. § 20.902; see March 2026 BVA Letter.

1. Entitlement to service connection for left ventricular hypertrophy, as secondary to service-connected hypertension, is granted.

2. Entitlement to service connection for Fabry's disease, as secondary to service-connected hypertension, is granted.

The Veteran contends that his left ventricular hypertrophy and Fabry's disease is due to his service-connected hypertension.  See September 2025 VA Form 20-0995 and October 2025 VA Form 10182.  The Board notes that the Veteran was service-connected for hypertension in an August 2007 rating decision and assigned a 10 percent rating effective February 8, 2007.

Legal Criteria

Service Connection

Establishing direct service connection generally requires competent evidence showing: (1) the existence of a current 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
, is granted.

The Veteran contends that his left ventricular hypertrophy and Fabry's disease is due to his service-connected hypertension.  See September 2025 VA Form 20-0995 and October 2025 VA Form 10182.  The Board notes that the Veteran was service-connected for hypertension in an August 2007 rating decision and assigned a 10 percent rating effective February 8, 2007.

Legal Criteria

Service Connection

Establishing direct service connection generally requires competent evidence showing: (1) the existence of a current 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 service.  38 U.S.C. §§ 1110, 1131; Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004).  Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Establishing service connection on a secondary basis requires evidence sufficient to show that: (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  38 C.F.R. § 3.310.  Secondary causation exists when, but for the service-connected disability, 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 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; 38 C.F.R. § 3.102, 4.3.  When a Veteran seeks benefits and the evidence is in relative equipoise, the Veteran prevails.  Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other.  Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

Evidence and Analysis

Following the Veteran's September 2025 supplemental claim, the AOJ requested VA examinations for both the Veteran's heart condition and Fabry's disease.  However, while a secondary service connection medical opinion was requested for the Veteran's heart condition, only a medical examination, and not a medical opinion, was requested for the Veteran's Fabry's disease.  See September 2025 Exam Request.  However, the Veteran provided a private medical opinion regarding Fabry's disease.  See September 2025 Medical Treatment Record Non-Government Facility.

The Veteran was provided with a VA kidney examination in October 2025.  The examiner marked the Veteran's Fabry's disease as a congenital or inherited kidney disorder, but also provided a diagnosis of renal failure.  The examiner indicated that the Veteran's Fabry's disease had been present since birth but had progressed or worsened to the point that he is unable to urinate and requires dialysis three times per week.

There is no VA medical opinion regarding Fabry's disease of record.

As noted above, the Veteran submitted a private medical opinion regarding Fabry's by a private provider, a cardiologist, in September 2025.  This private provider opined that it was at least as likely as not that the Veteran's Fabry's disease was aggravated by the Veteran's service-connected hypertension.  As rationale, the provider noted that in Fabry's disease, hypertension exacerbates existing kidney damage by accelerating chronic kidney disease progression.  Hypertension worsens kidney function by constricting blood vessels which is intensified in Fabry's disease, due to glycolipid deposits in the kidneys and a potential predisposition to inflammation and oxidative stress.  The private provider cited two National Institute of Health studies that support a correlation between these conditions.

In the context of secondary service connection, prob
 Fabry's by a private provider, a cardiologist, in September 2025.  This private provider opined that it was at least as likely as not that the Veteran's Fabry's disease was aggravated by the Veteran's service-connected hypertension.  As rationale, the provider noted that in Fabry's disease, hypertension exacerbates existing kidney damage by accelerating chronic kidney disease progression.  Hypertension worsens kidney function by constricting blood vessels which is intensified in Fabry's disease, due to glycolipid deposits in the kidneys and a potential predisposition to inflammation and oxidative stress.  The private provider cited two National Institute of Health studies that support a correlation between these conditions.

In the context of secondary service connection, probative value is afforded to the September 2025 private Fabry's medical opinion.  Notably, the cardiologist offered a definitive opinion supported by a detailed rationale which directly contemplates the Veteran's diagnosis, the current symptomology, and its relationship to the Veteran's service-connected hypertension.  There is no evidence that the private provider misstated any relevant fact in providing the opinion which was supported by a comprehensive review of the claims file and related medical research analysis.  As such, the Board finds the September 2025 private Fabry's medical opinion to be adequate.

The Veteran was also provided with an October 2025 VA heart examination.  The examiner provided a diagnosis of left ventricular hypertrophy.  The examiner noted a diagnosis since 2006 during active service, where the Veteran was found to have mild left ventricular hypertrophy, which progressed to experiencing shortness of breath and dizziness with physical exertion.  Further, the examiner noted in the etiology section of the examination that the Veteran's left ventricular hypertrophy was most likely caused by the Veteran's Fabry's disease and hypertension.

Based on the October 2025 VA heart examination, the VA examiner opined that the Veteran's left ventricular hypertrophy was at least as likely as not due to or the result of the Veteran's service-connected hypertension.  As rationale, the examiner noted that while the Veteran's kidney condition has been present since birth, he began to experience elevated blood pressure readings in 1993, which is prior to his left ventricular hypertrophy diagnosis.  This would provide ample time for the condition to develop due to uncontrolled hypertension.  The examiner indicated that "[while] the Veteran's kidney condition was a significant contributing factor, his hypertension also played a significant role in the development of ventricular hypertrophy; therefore, a secondary nexus is established."

In the context of secondary service connection, probative value is afforded to the October 2025 VA heart medical opinion.  Notably, the examiner offered a definitive opinion supported by a detailed rationale which directly contemplates the Veteran's diagnosis, the current symptomology, and its relationship to the Veteran's service-connected hypertension.  There is no evidence that the examiner misstated any relevant fact in providing the opinion which was supported by a comprehensive review of the claims file and related medical research analysis.  As such, the Board finds the October 2025 VA heart medical opinion to be adequate.

The Board notes that a negative TERA medical opinion was provided regarding the Veteran's left ventricular hypertrophy.  However, as the secondary service connection medical opinion has been found adequate, the Board need not discuss the negative TERA medical opinion.  Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence).

There are no other VA or private medical opinions of record.

Based on the above, and affording the Veteran the benefit of the doubt, the Board finds the September 2025 Fabry's private secondary service connection medical opinion and October 2025 VA heart secondary service connection medical opinion adequate.  As there are no other adequate medical opinions of record, the Board finds the elements of direct service connection have not been met.  However, the Board further finds the elements of secondary service connection have been met based on the secondary service connection medical opinions of record.  

As such, service connection for Fabry's disease and left ventricular hypertrophy, as secondary to the Veteran's service-connected hypertension, is warranted.  38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).  Accordingly, service connection, on a secondary basis, is granted.

 

 

Colleen M. Glaser-Allen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Daniel Stephens, Associate Counsel

The Board's decision in this
 secondary service connection medical opinions of record.  

As such, service connection for Fabry's disease and left ventricular hypertrophy, as secondary to the Veteran's service-connected hypertension, is warranted.  38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).  Accordingly, service connection, on a secondary basis, is granted.

 

 

Colleen M. Glaser-Allen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Daniel Stephens, 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.