HYPERTENSION

Summary

The Veteran, who served from June 1966 to September 1993, appeals the denial of service connection for a heart condition, specifically bradycardia with atrial fibrillation, claimed as secondary to his service-connected hypertension. The Board noted that the Veteran's initial claim for bradycardia, ventricular arrhythmia, and incomplete right bundle branch block was denied and became final. However, the Veteran later filed a new claim for atrial fibrillation secondary to hypertension, which the Board recharacterized as the primary issue. The Board found that the Veteran has a current heart condition, as established by a favorable finding from the AOJ and clarified by a December 2025 VA examination. Service connection for hypertension was already established. The key evidence was a November 2025 VA opinion, which found the Veteran's heart condition to be at least as likely as not proximately due to or the result of his hypertension. The examiner cited NIH information explaining that hypertension is a major risk factor for atrial fibrillation, causing structural and electrical changes in the heart's atria. The Board found this opinion highly probative and sufficient to establish the required nexus. Therefore, service connection for bradycardia with atrial fibrillation as secondary to hypertension was granted.

Rationale

Favorable finding of current heart condition; Service-connected hypertension established; Prohibitive VA opinion linking hypertension to atrial fibrillation

Full Decision Text

Citation Nr: A26040478
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260126-617768
DATE: April 30, 2026

ORDER

Entitlement to service connection for bradycardia with atrial fibrillation as secondary to hypertension (previously claimed as bradycardia, ventricular arrhythmia, and incomplete right bundle branch block) (heart condition) is granted.

FINDING OF FACT

The Veteran's bradycardia with atrial fibrillation (previously claimed as bradycardia, ventricular arrhythmia, and incomplete right bundle branch block) (heart condition) is proximately due to, or the result of his service-connected hypertension.

CONCLUSION OF LAW

The criteria for entitlement to service connection for bradycardia with atrial fibrillation secondary to hypertension (previously claimed as bradycardia, ventricular arrhythmia, and incomplete right bundle branch block) (heart condition) have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§?3.102, 3.159, 3.303, 3.310. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from June 1966 to September 1993.

The Appeals Modernization Act (AMA) creates a new framework for Veterans dissatisfied with Department of Veterans Affairs' (VA) decision on their claim to seek review. The AMA became effective on February 19, 2019. 38 C.F.R. §?3.2400(a)(1). The AMA applies to all initial decisions issued after February 19, 2019. 

The present matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2025 rating decision issued by VA Agency of Original Jurisdiction (AOJ). Accordingly, this decision is subject to the AMA. 

In a February 2023 rating decision, the AOJ denied the Veteran's claim for service connection for bradycardia, ventricular arrhythmia, and incomplete right bundle branch block (claimed as heart condition). The Veteran did not appeal this rating decision within the one year period, and the decision became final.

In June 2025, the Veteran submitted a new claim for entitlement to service connection for atrial fibrillation as secondary to his service-connected hypertension. The Veteran also submitted an October 2025 VA Form 20-0995: Supplemental Claim Application, which augmented the June 2025 claim with additional medical evidence. 

In a December 2025 rating decision, the AOJ denied service connection for bradycardia, ventricular arrythmia, and incomplete right bundle branch block. However, the Board notes that a December 2025 Addendum to VA examination clarified that the Veteran's heart condition diagnosis had progressed from bradycardia, ventricular arrythmia, and incomplete right bundle branch block and is now diagnosed as bradycardia with atrial fibrillation. As such, the claim has been recharacterized by the Board, notwithstanding the December 2025 rating decision, as a claim for entitlement to service connection for bradycardia with atrial fibrillation as secondary to hypertension (previously claimed as bradycardia, ventricular arrhythmia, and incomplete right bundle branch block) (heart condition).

Next, the Veteran timely appealed the December 2025 rating decision to the Board in a January 2026, VA Form 10182, Notice of Disagreement. Based on the Veteran's?selection?of the evidence docket, the Board can only consider evidence received up to the date of the rating decision on appeal and evidence received within 90 days of receipt of the VA Form 10182 Notice of Disagreement. 38 C.F.R. § 20.303.? 

Service Connection???? 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present 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-the so-called "nexus" requirement.?Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting?Shedden v. Principi, 38 F.3d 1163
 active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present 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-the so-called "nexus" requirement.?Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting?Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in a?denial of service?connection.????????? 

The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "[l]ay?evidence can be competent and sufficient to establish a diagnosis of?a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional."?Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007);?see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence").?????? 

Service connection may also be granted for any disease initially diagnosed after service when?all of?the evidence, including that pertinent to service,?establishes?that the disease was incurred in service. 38 C.F.R. § 3.303(d).?????? 

Service?connection?may alternatively be?established?on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be?established?for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree)?over and above the degree of disability existing prior to the aggravation.?See?38?C.F.R. § 3.310(b);?Allen v. Brown, 8?Vet. App.?374 (1995).?????? 

In order to?prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence?establishing?a connection between the service-connected disability and the current disability.?See Wallin v. West, 11?Vet. App.?509, 512 (1998);?see also?Allen,?supra.?????? 

Service connection must be considered on the basis of the places, types, and circumstances of a Veteran's service as shown by his or her service records, the official history of each organization in which he or she served, his or her medical records, and all pertinent medical and lay evidence.?See?38 C.F.R. § 3.303(a);?see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007);?and see Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006).????????? 

When there is an approximate balance of positive and negative evidence?regarding?any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §?3.102.???? 

Entitlement to service connection for bradycardia with atrial fibrillation secondary to hypertension (previously claimed as bradycardia, ventricular arrhythmia, and incomplete right bundle branch block) (heart condition)

The Veteran contends that his atrial fibrillation is secondary to his service-connected hypertension. Because the Board agrees that the Veteran's atrial fibrillation (heart condition) is secondary to the service-connected hypertension, it is not necessary for the Board to address other theories of entitlement. 

As to evidence of a current disability for a heart condition, the AOJ made a favorable finding that the Veteran has a current disability based on a diagnosis of a bradycardia, ventricular arrhythmia, and incomplete right bundle branch
 to service connection for bradycardia with atrial fibrillation secondary to hypertension (previously claimed as bradycardia, ventricular arrhythmia, and incomplete right bundle branch block) (heart condition)

The Veteran contends that his atrial fibrillation is secondary to his service-connected hypertension. Because the Board agrees that the Veteran's atrial fibrillation (heart condition) is secondary to the service-connected hypertension, it is not necessary for the Board to address other theories of entitlement. 

As to evidence of a current disability for a heart condition, the AOJ made a favorable finding that the Veteran has a current disability based on a diagnosis of a bradycardia, ventricular arrhythmia, and incomplete right bundle branch block, and the Board is bound by this finding. 38 C.F.R. 3.104(c). Thus, the Board finds that a current disability is established for a heart condition.  

With respect to evidence of a service-connected disability, the Veteran is service connected for hypertension. Thus, the second element of secondary service connection is satisfied.  

Regarding?a nexus?between the service-connected hypertension and the current disability of a heart condition, the Veteran was afforded VA examinations in November 2025 and December 2025, and the examinations indicated a diagnosis of bradycardia with atrial fibrillation. A VA opinion for secondary service connection was obtained in November 2025. The examiner opined that Veteran's heart condition is at least as likely as not proximately due to or the result of the Veteran's hypertension. As rationale, the examiner stated that atrial fibrillation is a common heart rhythm disorder where the atria (upper chambers of the heart) beat irregularly and rapidly, and that according to the National Institutes of Health, hypertension and left ventricular hypertrophy are major risk factors for atrial fibrillation. Furthermore, the examiner explained that hypertension causes atrial fibrillation by inducing both structural and electrical changes in the heart's upper chambers, known as the atria, and that high blood pressure forces the heart to work harder, leading to left ventricular hypertrophy and increased pressure on the atria. Thus, the examiner concluded that hypertension combined with hormonal influences leads to atrial remodeling ultimately creating a substrate for atrial fibrillation to develop. The conclusion is supported by adequate rationale, and the Board finds the November 2025 VA opinion highly probative. 

The Board notes that the November 2025 VA opinion is the only medical nexus opinion obtained pertaining to secondary service connection. As such, the Board finds the November 2025 VA opinion to be the most probative evidence of a nexus between the Veteran's heart condition and his service-connected hypertension. Thus, a nexus is established. 

Accordingly, service connection for the Veteran's heart condition as secondary to his service-connected hypertension is warranted, and the claim is granted. 

 

 

GAYLE STROMMEN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jeffreys, J.

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.