Secondary service connection
Hypertension secondary to a back condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided hypertension claimed as secondary to a back condition in 370 decisions. It granted the issue in 18.9% of them, close to the 17.6% grant rate for all hypertension issues, denied it in 21.6%, and remanded it in 58.1%. Counting only decisions on the merits, 46.7% were granted.
Decisions
370
2017–2026
Granted
18.9%
All hypertension: 17.6%
Granted on the merits
46.7%
Granted ÷ (granted + denied)
Remanded
58.1%
Denied: 21.6%
See all hypertension decisions, direct and secondary.
Hypertension secondary to a back condition: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2017 | 21 | 14.3% | 33.3% | 38.1% |
| 2018 | 22 | 4.5% | 27.3% | 63.6% |
| 2019 | 29 | 6.9% | 24.1% | 69.0% |
| 2020 | 44 | 6.8% | 29.5% | 63.6% |
| 2021 | 45 | 20.0% | 28.9% | 51.1% |
| 2022 | 40 | 15.0% | 10.0% | 75.0% |
| 2023 | 44 | 36.4% | 11.4% | 52.3% |
| 2024 | 53 | 24.5% | 22.6% | 52.8% |
| 2025 | 54 | 24.1% | 16.7% | 59.3% |
Evidence in granted and denied hypertension decisions
For each kind of supporting evidence: how often the Board granted the hypertension issue on the merits when the decision mentioned it, compared with decisions that did not. These are associations, not causes, and evidence is recorded per decision, not per issue.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Positive nexus opinion | 89 | 81.4% | 24.2% | +57.2 pts |
| Private medical opinion | 141 | 61.0% | 29.4% | +31.6 pts |
| Lay statement | 285 | 35.3% | 90.3% | −55.0 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 77.1% of the decisions that granted hypertension.
- The Board found the veteran's statements credible in 11.4% of grants and 5.0% of denials.
Negative evidence in the record
An unfavorable exam or a negative nexus opinion often sits in the same record as favorable evidence, and the Board weighs them against each other. So these rows show how often hypertension was still granted when the record contained the negative item, not that the item helped.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Negative nexus opinion | 279 | 40.5% | 67.6% | −27.1 pts |
| Unfavorable VA exam | 310 | 40.5% | 89.5% | −49.0 pts |
Why the Board granted or denied hypertension
Most common reasons in grants
- Caused by the service-connected disability14
- Service connection established10
- Current diagnosis established8
- Aggravated by the service-connected disability3
- Obesity as intermediate step3
- Hypertension would not have occurred but for obesity2
- Obesity as an intermediate step2
- Obesity was substantial factor in causing hypertension2
Most common reasons in denials
- VA examiner: less likely than not related to service22
- No in-service complaints, treatment or diagnosis14
- Preponderance of the evidence against the claim9
- Service records negative or silent7
- Caused by the service-connected disability5
- No current diagnosis4
- Aggravated by the service-connected disability4
- No continuity of symptomatology3
Numbers are decisions that gave the reason. Reasons are short phrases extracted by AI from each decision; common wordings of the same reason are grouped. Benefit of the doubt is reported above.
Recent hypertension decisions
Granted
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.
Temporary aggravation may suffice for secondary service connection.; Evidence of record could be reasonably characterized as in approximate balance.; Resolved reasonable doubt in the Veteran's favor.
New and relevant evidence submitted post-hearing.; Private medical opinion links hypertension to obesity caused by service-connected back disability.; Opinion found probative and based on review of record and examination.
Denied
Hypertension not diagnosed in service or within presumptive period.; No continuity of symptomatology from service.; No evidence of hypertension in service or causal link.; VA examiner found less likely than not that hypertension caused by back disability.; Private nexus opinion lacked reasoned medical explanation.
New evidence submitted was not relevant to the claim.; No new and relevant evidence since prior denial.; Weight of evidence against claim; benefit of doubt not applicable.
No chronic in-service symptoms or continuity; Negative nexus opinions from VA examiners (Oct 2024, Aug 2025); No established pathophysiological link to service-connected conditions or TERA
Rules that apply to secondary hypertension claims
- 38 CFR 3.310
Secondary service connection and aggravation
Read it in VA Law Explorer - M21-1 V.ii.2.D
Secondary service connection and aggravation of non-service-connected disabilities
Read it in VA Law Explorer - 38 CFR 3.102
Reasonable doubt (benefit of the doubt)
Read it in VA Law Explorer - 38 CFR 4.104 · DC 7101
Schedule of ratings: cardiovascular system
Read it in VA Law Explorer - M21-1 V.iii.5.3
Hypertension: definitions, blood pressure readings required, predominant blood pressure
Read it in VA Law Explorer - M21-1 V.iii.11.2.e
When hypertension is or is not a complication of diabetes
Read it in VA Law Explorer
Research your hypertension case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
How these numbers are calculated
- Counts decisions in which the Board decided a hypertension issue claimed as secondary to a back condition, by the outcome of that issue.
- The primary disability is read from the decision text ("secondary to …") and grouped by name, so spellings such as "PTSD" and "posttraumatic stress disorder" count together.
- Secondary claims also include aggravation of a non-service-connected condition by a service-connected one (38 CFR 3.310(b)).
- The data comes from CaseScribe's AI extraction of public BVA decisions (2017–2026) and can contain errors. It is updated automatically as new decisions are added.