Secondary service connection
Hypertension secondary to diabetes: BVA grant rates and what wins
From 2018 to 2026, the Board of Veterans' Appeals decided hypertension claimed as secondary to diabetes in 2,496 decisions. It granted the issue in 16.1% of them, below the 18.3% grant rate for all hypertension issues, denied it in 22.9%, and remanded it in 59.7%. Counting only decisions on the merits, 41.3% were granted.
Decisions
2,496
2018–2026
Granted
16.1%
All hypertension: 18.3%
Granted on the merits
41.3%
Granted ÷ (granted + denied)
Remanded
59.7%
Denied: 22.9%
See all hypertension decisions, direct and secondary.
Hypertension secondary to diabetes: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2018 | 470 | 13.4% | 33.2% | 50.9% |
| 2019 | 411 | 13.4% | 17.0% | 67.2% |
| 2020 | 474 | 9.5% | 25.7% | 63.7% |
| 2021 | 459 | 11.3% | 25.3% | 62.3% |
| 2022 | 304 | 19.7% | 17.4% | 63.2% |
| 2023 | 170 | 32.9% | 13.5% | 54.1% |
| 2024 | 98 | 29.6% | 15.3% | 53.1% |
| 2025 | 75 | 38.7% | 18.7% | 41.3% |
| 2026 | 35 | 34.3% | 5.7% | 60.0% |
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 | 469 | 86.1% | 19.7% | +66.4 pts |
| Favorable VA exam | 284 | 83.9% | 30.3% | +53.6 pts |
| Treating physician opinion | 144 | 65.4% | 39.1% | +26.4 pts |
| Private medical opinion | 767 | 53.9% | 32.6% | +21.3 pts |
| Combat service | 214 | 45.3% | 40.8% | +4.4 pts |
| Lay statement | 1,684 | 34.8% | 62.6% | −27.8 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 76.6% of the decisions that granted hypertension.
- The Board found the veteran's statements credible in 20.9% of grants and 6.3% 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 | 1,506 | 31.6% | 61.5% | −29.9 pts |
| Unfavorable VA exam | 1,805 | 35.3% | 65.3% | −30.0 pts |
Why the Board granted or denied hypertension
Most common reasons in grants
- Caused by the service-connected disability69
- Current diagnosis established50
- Service connection established37
- Aggravated by the service-connected disability32
- VA examiner: less likely than not related to service4
- New and material evidence submitted to reopen claim4
- Hypertension diagnosed4
- Veteran diagnosed with hypertension3
Most common reasons in denials
- VA examiner: less likely than not related to service122
- No in-service complaints, treatment or diagnosis97
- Preponderance of the evidence against the claim60
- Service records negative or silent53
- Aggravated by the service-connected disability26
- No continuity of symptomatology20
- Continuity of symptomatology since service13
- No current diagnosis12
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
VA examiner's opinion on hypertension was inadequate.; Board found Veteran's hypertension secondary to DMII based on multiple opinions.; November 2023 opinion noted DMII likely worsened kidney disease and hypertension.
Granted secondary to DM; VA clinicians opined DM causes/aggravates hypertension; Resolved doubt in Veteran's favor
Hypertension aggravated by service-connected diabetes; Favorable VA opinion on secondary aggravation; Equipoise standard met
Denied
Hypertension claimed secondary to diabetes mellitus, which was not service-connected.; Condition did not onset during service or within one year of separation.; No continuity of symptoms from service to diagnosis.
No evidence of in-service incurrence or aggravation; Condition diagnosed many years after service; Chronic kidney disease noted as secondary to hypertension and diabetes
No in-service diagnosis or complaints of hypertension.; Hypertension manifested decades after service, not continuously or within one year of separation.; No direct nexus between hypertension and service or toxic exposures.; Secondary claim to diabetes denied as diabetes is not service-connected.
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 diabetes, 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 (2018–2026) and can contain errors. It is updated automatically as new decisions are added.