HYPERTENSION

ANTHONY C. SCIRÉ, JR · 2026 · Case ID: A26040091

GRANTED

Summary

The Veteran served in the United States Army from June 1990 to August 1996. This case concerns the Veteran's appeal of an April 2025 rating decision regarding service connection for hypertension. The Veteran sought to establish hypertension as secondary to his already service-connected degenerative disc disease (DDD) with degenerative arthritis of the thoracolumbar spine. The Board reviewed the evidence, including a favorable finding from the AOJ that the Veteran has a current diagnosis of hypertension. A key piece of evidence was a June 2023 private medical opinion from a licensed physician assistant. This opinion diagnosed hypertension and opined that it was due to or aggravated by the service-connected thoracolumbar DDD. The provider reasoned that the chronic pain from DDD led to decreased physical activity and weight gain, contributing to hypertension. The Board found this opinion probative. While VA medical opinions in the record found it less likely than not that hypertension was due to or aggravated by the service-connected condition, the Board found these opinions inadequate because they applied a stricter "proximate cause" standard than required. The Board determined the evidence was in approximate balance regarding the secondary connection. Applying the benefit-of-the-doubt doctrine, the Board resolved the doubt in the Veteran's favor. Consequently, service connection for hypertension as secondary to DDD with degenerative arthritis of the thoracolumbar spine was granted.

Rationale

Private medical opinion found hypertension due to or aggravated by service-connected thoracolumbar DDD.; VA opinions using "proximate cause" standard were deemed inadequate.; Evidence found in approximate balance; benefit of doubt resolved in Veteran's favor.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250828-580131

Full Decision Text

Citation Nr: A26040091
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250828-580131
DATE: April 29, 2026

ORDER

Entitlement to service connection for hypertension as secondary to degenerative disc disease (DDD) with degenerative arthritis of the thoracolumbar spine is granted.

FINDING OF FACT

The Veteran's hypertension is due to or aggravated by his service-connected DDD with degenerative arthritis of the thoracolumbar spine.

CONCLUSION OF LAW

The criteria for service connection for hypertension as secondary to DDD with degenerative arthritis of the thoracolumbar spine. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from June 1990 to August 1996.

This matter comes before the Board on appeal of an April 2025 rating decision. In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Entitlement to service connection for hypertension as secondary to DDD with degenerative arthritis of the thoracolumbar is granted.

"Secondary service connection will be granted if a disability is... due to or the result of a service-connected disease or injury or aggravated by a service-connected disease or injury." 38 C.F.R. § 3.310; Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023) (secondary service connection requires "but-for causation," which is "broader than proximate causation").

In Spicer, the Federal Circuit held that under the causation standard of 38 U.S.C. § 1110, secondary service connection is warranted where a nonservice-connected disability would have been less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the nonservice-connected disability. The Federal Circuit specifically found that requiring "proximate cause" in secondary service connection appeals is a stricter standard than the "but-for cause" standard in 38 U.S.C. § 1110 and, therefore, is unlawful.

Here, in the April 2025 rating decision, the AOJ favorably found the Veteran has a current diagnosis for hypertension. The Board is bound by this favorable finding of fact as the record does not contain clear and unmistakable error to rebut it. See 38 C.F.R. § 20.801(a).

In June 2023, VA received a private medical opinion. The private medical provider continued a diagnosis of hypertension and opined the Veteran's hypertension was due to or aggravated by his service-connected DDD with degenerative arthritis of the thoracolumbar spine. The private medical provider reasoned that the Veteran's service-connected DDD with degenerative arthritis of the thoracolumbar spine caused "significant pain" which prevented him from engaging in "substantial[ly] meaningful exercise." The Veteran's chronic pain resulted in "decreased physical activity and subsequent weight gain." The private medical provider reviewed studies and literature addressing hypertension and chronic pain, the effect of decreased activity as related to obesity, and the relationship between hypertension and obesity. The private medical opinion was provided by a licensed physician assistant who used reliable principles and methods of observation, fact-gathering, and analysis to continue a diagnosis of hypertension and determine the Veteran's hypertension was due to or aggravated by his service-connected DDD with degenerative arthritis of the thoracolumbar spine. As such, the Board affords this opinion probative value.

The Board acknowledges several VA medical opinions of record. However, upon weighing the evidence of record, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's hypertension was due to or aggravated by his service-connected DDD with degenerative arthritis of the thoracolumbar spine. See Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (holding "if the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt"). Pursuant to the "benefit-of-the-doubt" rule, where there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue. 38 U.S.C. § 5107(b). Although there is some evidence against the claim insofar as VA medical opinions found it less likely than not that the Veteran's hypertension was due to or aggravated by his service-connected DDD with degenerative arthritis of the thoracolumbar spine, the Board finds that evidence is of limited probative value as the "proximate cause" standard was used and therefore the opinions are inadequate.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for hypertension as secondary to service-connected DDD with degenerative arthritis of the thoracolumbar spine. See Lynch, 21 F.4th at 781; see also Gilbert v. Derwinski, 1?Vet. App.?49, 55-56 (1990) ("[T]he 'benefit of the doubt' standard is similar to the rule deeply embedded in sandlot baseball folklore that 'the tie goes to the runner'.... [I]f... the play is close, i.e., 'there is an approximate balance of positive and negative evidence,' the veteran prevails by operation of [statute]."). Therefore, entitlement to service connection for hypertension as secondary to service-connected DDD with degenerative arthritis of the thoracolumbar spine is granted.

ANTHONY C. SCIRÉ, JR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mills, 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.

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